Provider First Line Business Practice Location Address:
100 FOLSOM PRISON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REPRESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95671-5201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-477-1416
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2023