Provider First Line Business Practice Location Address:
344 PLACEVILLE DRIVE
Provider Second Line Business Practice Location Address:
SUITE #19
Provider Business Practice Location Address City Name:
PLACEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-626-9127
Provider Business Practice Location Address Fax Number:
530-626-9418
Provider Enumeration Date:
08/23/2006