Provider First Line Business Practice Location Address:
353 2ND 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:
95616-4607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-758-2122
Provider Business Practice Location Address Fax Number:
530-758-1448
Provider Enumeration Date:
04/24/2013