Provider First Line Business Practice Location Address:
719 2ND ST
Provider Second Line Business Practice Location Address:
STE 3
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:
530-753-2032
Provider Business Practice Location Address Fax Number:
530-753-2032
Provider Enumeration Date:
10/31/2007