Provider First Line Business Practice Location Address:
2330 W. COVELL BLVD
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:
95616-5058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-406-2842
Provider Business Practice Location Address Fax Number:
530-756-5817
Provider Enumeration Date:
06/29/2006