Provider First Line Business Practice Location Address:
2021 SMITH FLAT RD
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:
95667-5038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-409-0677
Provider Business Practice Location Address Fax Number:
530-295-8266
Provider Enumeration Date:
08/25/2009