Provider First Line Business Practice Location Address:
100 PRISON ROAD
Provider Second Line Business Practice Location Address:
CA DEPT OF CORRECTION AND REHABILITATION
Provider Business Practice Location Address City Name:
REPRESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95671-0012
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:
916-294-3056
Provider Enumeration Date:
03/06/2007