Provider First Line Business Practice Location Address:
17328 PENN VALLEY DR.
Provider Second Line Business Practice Location Address:
STE. C
Provider Business Practice Location Address City Name:
PENN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-432-3450
Provider Business Practice Location Address Fax Number:
530-432-3572
Provider Enumeration Date:
12/29/2006