Provider First Line Business Practice Location Address:
11434 B AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95603-2603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-906-0837
Provider Business Practice Location Address Fax Number:
530-886-2992
Provider Enumeration Date:
04/01/2026