Provider First Line Business Practice Location Address:
1111 HIGH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95603-5109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-736-1273
Provider Business Practice Location Address Fax Number:
530-885-8416
Provider Enumeration Date:
04/12/2007