Provider First Line Business Practice Location Address:
941 SPRING ST
Provider Second Line Business Practice Location Address:
STE. 7
Provider Business Practice Location Address City Name:
PLACERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95667-4546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-621-6236
Provider Business Practice Location Address Fax Number:
530-295-2589
Provider Enumeration Date:
04/02/2007