Provider First Line Business Practice Location Address:
929 SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLACERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-621-6146
Provider Business Practice Location Address Fax Number:
530-387-2308
Provider Enumeration Date:
09/14/2010