Provider First Line Business Practice Location Address:
3872 STATE HIGHWAY 49
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:
95667-6313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-295-7114
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/20/2021