Provider First Line Business Practice Location Address:
1223 HIGH ST SPC C-1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95603-5017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-308-7982
Provider Business Practice Location Address Fax Number:
425-502-8141
Provider Enumeration Date:
10/01/2006