Provider First Line Business Practice Location Address:
7563 GREEN VALLEY RD
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:
95667-3917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-622-2323
Provider Business Practice Location Address Fax Number:
530-622-2011
Provider Enumeration Date:
12/12/2006