Provider First Line Business Practice Location Address:
2440 W COVELL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95616-5671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-668-2646
Provider Business Practice Location Address Fax Number:
530-662-5120
Provider Enumeration Date:
10/30/2012