Provider First Line Business Practice Location Address:
11899 EDGEWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95603-3437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-823-3734
Provider Business Practice Location Address Fax Number:
530-823-5432
Provider Enumeration Date:
01/09/2007