Provider First Line Business Practice Location Address:
2100 5TH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-753-0220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2009