Provider First Line Business Practice Location Address:
2914 COLD SPRINGS RD STE B
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:
95667-4237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-626-9240
Provider Business Practice Location Address Fax Number:
530-626-8992
Provider Enumeration Date:
12/27/2010