Provider First Line Business Practice Location Address:
6520 PLEASANT VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DIAMOND SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-621-7820
Provider Business Practice Location Address Fax Number:
530-621-4503
Provider Enumeration Date:
06/28/2005