Provider First Line Business Practice Location Address:
6840 OAK LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLACERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95667-6723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-642-7800
Provider Business Practice Location Address Fax Number:
888-870-9642
Provider Enumeration Date:
07/15/2026