Provider First Line Business Practice Location Address:
509 A FOURTH ST.
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-219-3510
Provider Business Practice Location Address Fax Number:
530-475-6735
Provider Enumeration Date:
02/10/2007