Provider First Line Business Practice Location Address:
1230 HIGH ST
Provider Second Line Business Practice Location Address:
SUITE 120A
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95603-5043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-320-4169
Provider Business Practice Location Address Fax Number:
530-346-7749
Provider Enumeration Date:
03/10/2007