Provider First Line Business Practice Location Address:
31292 ALPINE MEADOWS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHINGLETOWN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96088-9462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-474-3390
Provider Business Practice Location Address Fax Number:
530-474-1407
Provider Enumeration Date:
11/02/2018