Provider First Line Business Practice Location Address:
12140 NEW YORK RANCH ROAD
Provider Second Line Business Practice Location Address:
JACKSON RANCHERIA HEALTH COMPLEX
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95642-9344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-257-2430
Provider Business Practice Location Address Fax Number:
209-257-2434
Provider Enumeration Date:
06/22/2005