Provider First Line Business Practice Location Address:
1880 PRAIRIE CITY RD
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
FOLSOM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95630-9593
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-985-7848
Provider Business Practice Location Address Fax Number:
888-789-4512
Provider Enumeration Date:
07/27/2009