Provider First Line Business Practice Location Address:
11899 EDGEWOOD RD STE B
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:
95603-3435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-878-5158
Provider Business Practice Location Address Fax Number:
530-878-5159
Provider Enumeration Date:
09/18/2017