Provider First Line Business Practice Location Address:
2121 CALAVERAS AVE
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:
95616-3071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-757-5430
Provider Business Practice Location Address Fax Number:
530-757-5434
Provider Enumeration Date:
04/30/2025