Provider First Line Business Practice Location Address:
16893 PLACER HILLS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEADOW VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95722-9531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-878-7440
Provider Business Practice Location Address Fax Number:
530-878-2470
Provider Enumeration Date:
06/14/2005