Provider First Line Business Practice Location Address:
1000 FOWLER WAY STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLACERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95667-5738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-626-0058
Provider Business Practice Location Address Fax Number:
530-626-0092
Provider Enumeration Date:
08/29/2007