Provider First Line Business Practice Location Address:
2079 ANDERSON RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
DAVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95616-0672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-758-8120
Provider Business Practice Location Address Fax Number:
530-758-8123
Provider Enumeration Date:
09/30/2006