Provider First Line Business Practice Location Address:
423 E ST
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:
95616-4132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-753-4636
Provider Business Practice Location Address Fax Number:
530-753-4655
Provider Enumeration Date:
05/30/2007