Provider First Line Business Practice Location Address:
1 MEDICAL PLAZA DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-454-7533
Provider Business Practice Location Address Fax Number:
916-454-6780
Provider Enumeration Date:
12/30/2010