Provider First Line Business Practice Location Address:
5 MEDICAL PLAZA DR
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-262-2370
Provider Business Practice Location Address Fax Number:
916-262-9375
Provider Enumeration Date:
06/19/2007