Provider First Line Business Practice Location Address:
2914 COLD SPRINGS RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PLACERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95667-4220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-389-9208
Provider Business Practice Location Address Fax Number:
530-389-9209
Provider Enumeration Date:
10/28/2008