Provider First Line Business Practice Location Address:
128 YANKTON ST
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:
95630-8142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-985-7948
Provider Business Practice Location Address Fax Number:
916-985-2724
Provider Enumeration Date:
11/10/2005