Provider First Line Business Practice Location Address:
1103 HIGH STREET
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95603-5124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-885-4673
Provider Business Practice Location Address Fax Number:
530-888-9193
Provider Enumeration Date:
11/23/2007