Provider First Line Business Practice Location Address:
2839 SPAFFORD ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
DAVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95616-6801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-758-8828
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2006