Provider First Line Business Practice Location Address:
3171 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE B
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:
530-626-3550
Provider Business Practice Location Address Fax Number:
530-626-5963
Provider Enumeration Date:
07/31/2006