Provider First Line Business Practice Location Address:
1366 PRAIRIE CITY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOLSOM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95630-9554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-829-8550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2022