Provider First Line Business Practice Location Address:
12280 SHALE RIDGE LANE
Provider Second Line Business Practice Location Address:
#1
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95602-8417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-888-9600
Provider Business Practice Location Address Fax Number:
530-888-9797
Provider Enumeration Date:
10/02/2006