Provider First Line Business Practice Location Address:
5306 HARRISON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH HIGHLANDS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95660-5414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-692-5644
Provider Business Practice Location Address Fax Number:
916-900-4497
Provider Enumeration Date:
07/29/2014