Provider First Line Business Practice Location Address:
129 C ST
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
DAVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95616-4588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-643-7546
Provider Business Practice Location Address Fax Number:
888-782-0169
Provider Enumeration Date:
02/22/2007