Provider First Line Business Practice Location Address:
12171 DRY CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95602-8475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-330-7321
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2025