Provider First Line Business Practice Location Address:
3171 WASHINGTON ST.
Provider Second Line Business Practice Location Address:
#D
Provider Business Practice Location Address City Name:
PLACERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95667-5831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-626-6320
Provider Business Practice Location Address Fax Number:
530-626-5573
Provider Enumeration Date:
06/06/2008