Provider First Line Business Practice Location Address:
699 MAIN ST STE B
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:
95667-5760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-295-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2021