Provider First Line Business Practice Location Address:
100 PRISON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REPRESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95671-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-985-8610
Provider Business Practice Location Address Fax Number:
916-294-3066
Provider Enumeration Date:
06/30/2009