Provider First Line Business Practice Location Address:
7981 HIGHWAY 99E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS MOLINOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96055-9782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-384-4010
Provider Business Practice Location Address Fax Number:
530-384-4016
Provider Enumeration Date:
08/01/2013