Provider First Line Business Practice Location Address:
929 SPRING STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLACERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-621-6335
Provider Business Practice Location Address Fax Number:
530-295-2772
Provider Enumeration Date:
03/02/2016