Provider First Line Business Practice Location Address:
6065 HIGHWAY 193
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-333-2548
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2016