Provider First Line Business Practice Location Address:
344 PLACERVILLE DR
Provider Second Line Business Practice Location Address:
SUITE 19
Provider Business Practice Location Address City Name:
PLACERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95667-3920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-626-9127
Provider Business Practice Location Address Fax Number:
530-626-9419
Provider Enumeration Date:
07/12/2005