Provider First Line Business Practice Location Address:
3 MEDICAL PLAZA DRIVE, SUITE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95661-0602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-773-8750
Provider Business Practice Location Address Fax Number:
916-773-7963
Provider Enumeration Date:
12/19/2006