Provider First Line Business Practice Location Address:
1111 KENNEDY PL
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
DAVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95616-1266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-753-2020
Provider Business Practice Location Address Fax Number:
530-753-7441
Provider Enumeration Date:
02/10/2007