Provider First Line Business Practice Location Address:
1520 E. COVELL BLVD
Provider Second Line Business Practice Location Address:
B5-493
Provider Business Practice Location Address City Name:
DAVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95616-1366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-424-2201
Provider Business Practice Location Address Fax Number:
530-237-0437
Provider Enumeration Date:
09/16/2024