Provider First Line Business Practice Location Address:
14715 EAST HWY 20
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARLAKE OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-998-1800
Provider Business Practice Location Address Fax Number:
707-998-0122
Provider Enumeration Date:
07/18/2024