Provider First Line Business Practice Location Address: 
416 AUBURN FOLSOM 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: 
95603-5515
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
530-786-7050
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
09/11/2021