Provider First Line Business Practice Location Address:
4340 GOLDEN CENTER DR STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLACERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95667-6258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-622-2020
Provider Business Practice Location Address Fax Number:
530-622-2212
Provider Enumeration Date:
06/13/2024