Provider First Line Business Practice Location Address:
11795 EDUCATION ST
Provider Second Line Business Practice Location Address:
STE 220
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95602-2469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-888-9907
Provider Business Practice Location Address Fax Number:
530-888-9903
Provider Enumeration Date:
05/19/2006