Provider First Line Business Practice Location Address:
850 N LAKE BLVD
Provider Second Line Business Practice Location Address:
20A
Provider Business Practice Location Address City Name:
TAHOE CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96145-5546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-583-8100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2023