Provider First Line Business Practice Location Address:
604 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95616-4553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-758-1162
Provider Business Practice Location Address Fax Number:
530-758-1162
Provider Enumeration Date:
02/20/2007