Provider First Line Business Practice Location Address:
2350 EAST BIDWELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOLSOM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95630-3455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-984-3899
Provider Business Practice Location Address Fax Number:
916-984-6522
Provider Enumeration Date:
05/19/2006