Provider First Line Business Practice Location Address:
1835 PRAIRIE CITY RD
Provider Second Line Business Practice Location Address:
SUITE #200
Provider Business Practice Location Address City Name:
FOLSOM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95630-9582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-351-9457
Provider Business Practice Location Address Fax Number:
916-351-9852
Provider Enumeration Date:
02/04/2009