Provider First Line Business Practice Location Address:
1100 MARSHALL WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLACERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95667-6533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-626-2613
Provider Business Practice Location Address Fax Number:
530-344-5434
Provider Enumeration Date:
03/30/2006