Provider First Line Business Practice Location Address:
112 A ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95616-4608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-752-2727
Provider Business Practice Location Address Fax Number:
530-752-4542
Provider Enumeration Date:
11/24/2009