Provider First Line Business Practice Location Address:
899 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:
95667-4437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-621-3600
Provider Business Practice Location Address Fax Number:
530-621-3668
Provider Enumeration Date:
01/10/2007