Provider First Line Business Practice Location Address:
2260 E BIDWELL ST
Provider Second Line Business Practice Location Address:
STE 108
Provider Business Practice Location Address City Name:
FOLSOM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95630-3554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-984-6555
Provider Business Practice Location Address Fax Number:
916-984-6777
Provider Enumeration Date:
08/14/2009