Provider First Line Business Practice Location Address:
681 FIFTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95565-9748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-223-0532
Provider Business Practice Location Address Fax Number:
707-306-7181
Provider Enumeration Date:
02/19/2026