Provider First Line Business Practice Location Address:
11879 KEMPER RD STE 3
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:
95603-9021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-885-3154
Provider Business Practice Location Address Fax Number:
530-885-3192
Provider Enumeration Date:
11/30/2011