Provider First Line Business Practice Location Address:
9340 DESCHUTES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALO CEDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96073-9763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-233-3113
Provider Business Practice Location Address Fax Number:
530-233-3140
Provider Enumeration Date:
06/26/2026