Provider First Line Business Practice Location Address:
670 PLACERVILLE DR
Provider Second Line Business Practice Location Address:
SUITE 1B
Provider Business Practice Location Address City Name:
PLACERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95667-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-621-6200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2011