Provider First Line Business Practice Location Address:
1321 W. COVELL BLVD.
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
DAVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-758-3937
Provider Business Practice Location Address Fax Number:
530-758-3938
Provider Enumeration Date:
01/23/2008