Provider First Line Business Practice Location Address:
719 2ND ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95616-4656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-758-2489
Provider Business Practice Location Address Fax Number:
530-297-1749
Provider Enumeration Date:
01/03/2007