Provider First Line Business Practice Location Address:
2100 5TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-747-3496
Provider Business Practice Location Address Fax Number:
530-753-0398
Provider Enumeration Date:
09/27/2006