Provider First Line Business Practice Location Address:
6221 MONITOR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL DORADO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95623-4534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-622-9522
Provider Business Practice Location Address Fax Number:
530-626-6888
Provider Enumeration Date:
11/07/2022