Provider First Line Business Practice Location Address:
129 C ST STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95616-4588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-341-2016
Provider Business Practice Location Address Fax Number:
530-231-6376
Provider Enumeration Date:
10/08/2019