Provider First Line Business Practice Location Address:
2545 E BIDWELL ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOLSOM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95630-6443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-984-6200
Provider Business Practice Location Address Fax Number:
916-235-7469
Provider Enumeration Date:
10/23/2006