Provider First Line Business Practice Location Address:
101 ORANGE ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95603-5232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-852-5066
Provider Business Practice Location Address Fax Number:
530-888-8793
Provider Enumeration Date:
04/24/2012