Provider First Line Business Practice Location Address:
44539 HIGHWAY 96
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEIAD VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-496-3308
Provider Business Practice Location Address Fax Number:
530-496-3310
Provider Enumeration Date:
02/10/2025