Provider First Line Business Practice Location Address:
3257 PROFESSIONAL DR STE B
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:
95602-2460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-823-6363
Provider Business Practice Location Address Fax Number:
530-823-6388
Provider Enumeration Date:
09/14/2009