Provider First Line Business Practice Location Address:
1243 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAYFORK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-628-5517
Provider Business Practice Location Address Fax Number:
530-628-5524
Provider Enumeration Date:
07/01/2006