Provider First Line Business Practice Location Address:
6390 RUNNYMEADE DR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLACERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95667-8634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-622-3600
Provider Business Practice Location Address Fax Number:
530-622-3865
Provider Enumeration Date:
06/29/2006