Provider First Line Business Practice Location Address:
2100 PEABODY RD.
Provider Second Line Business Practice Location Address:
DENTAL DEPT.
Provider Business Practice Location Address City Name:
VACAVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95696-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-451-0182
Provider Business Practice Location Address Fax Number:
707-454-3485
Provider Enumeration Date:
12/04/2007