Provider First Line Business Practice Location Address:
2545 E BIDWELL ST
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
FOLSOM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95630-6440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-984-6111
Provider Business Practice Location Address Fax Number:
916-983-1717
Provider Enumeration Date:
09/28/2009