Provider First Line Business Practice Location Address:
162 EAST CARSON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUSA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95932-1238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-458-0520
Provider Business Practice Location Address Fax Number:
916-458-7171
Provider Enumeration Date:
08/31/2006