Provider First Line Business Practice Location Address:
8605 AUBURN FOLSOM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANITE BAY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95746-6202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-872-1120
Provider Business Practice Location Address Fax Number:
916-872-1125
Provider Enumeration Date:
12/06/2005