Provider First Line Business Practice Location Address:
9336 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:
530-547-5744
Provider Business Practice Location Address Fax Number:
530-547-5791
Provider Enumeration Date:
10/04/2006