Provider First Line Business Practice Location Address:
228 B 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:
95616-4505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-219-3848
Provider Business Practice Location Address Fax Number:
530-757-2705
Provider Enumeration Date:
07/31/2007