Provider First Line Business Practice Location Address:
148 MAPLE ST
Provider Second Line Business Practice Location Address:
SUITE C-1
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95603-5041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-305-1843
Provider Business Practice Location Address Fax Number:
530-269-0178
Provider Enumeration Date:
04/05/2010