Provider First Line Business Practice Location Address:
24512 EDGEWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEED
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96094-9574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-938-2255
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2025