Provider First Line Business Practice Location Address:
1040 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:
85667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-622-3400
Provider Business Practice Location Address Fax Number:
530-622-3407
Provider Enumeration Date:
12/07/2006