Provider First Line Business Practice Location Address:
14715 EAST HIGHWAY 20
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARLAKE OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-998-1800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2024