Provider First Line Business Practice Location Address:
681 MAIN ST STE 212
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:
95667-5748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-306-7020
Provider Business Practice Location Address Fax Number:
530-725-5707
Provider Enumeration Date:
06/09/2007