Provider First Line Business Practice Location Address:
893 SPRING ST
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:
95667-4437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-622-8193
Provider Business Practice Location Address Fax Number:
530-622-4017
Provider Enumeration Date:
04/28/2008