Provider First Line Business Practice Location Address:
941 SPRING ST
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
PLACERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95667-4546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-622-9131
Provider Business Practice Location Address Fax Number:
530-622-9138
Provider Enumeration Date:
01/08/2007