Provider First Line Business Practice Location Address:
1000 FOWLER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLACERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95667-4511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
531-621-3600
Provider Business Practice Location Address Fax Number:
530-626-7617
Provider Enumeration Date:
10/19/2006