Provider First Line Business Practice Location Address:
422 E BIDWELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOLSOM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95630-3117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-293-8897
Provider Business Practice Location Address Fax Number:
916-358-7886
Provider Enumeration Date:
02/02/2010