Provider First Line Business Practice Location Address:
1815 PRAIRIE CITY ROAD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FOLSOM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-985-7100
Provider Business Practice Location Address Fax Number:
916-985-9588
Provider Enumeration Date:
05/15/2006