Provider First Line Business Practice Location Address:
600 N. LAKE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAHOE CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96145-6869
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-583-0002
Provider Business Practice Location Address Fax Number:
530-583-0044
Provider Enumeration Date:
10/31/2006