Provider First Line Business Practice Location Address:
687-440 HEMLOCK WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUSANVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96130-9622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-825-3506
Provider Business Practice Location Address Fax Number:
530-825-3506
Provider Enumeration Date:
01/27/2021