Provider First Line Business Practice Location Address:
5 MEDICAL PLAZA DRIVE
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-783-8114
Provider Business Practice Location Address Fax Number:
916-783-8116
Provider Enumeration Date:
12/11/2006