Provider First Line Business Practice Location Address:
3901 MISSOURI FLAT RD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-626-0338
Provider Business Practice Location Address Fax Number:
530-622-5250
Provider Enumeration Date:
08/30/2006