Provider First Line Business Practice Location Address:
12344 FAIR OAKS BLVD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
FAIR OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95628-2546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-726-2427
Provider Business Practice Location Address Fax Number:
916-726-2380
Provider Enumeration Date:
02/22/2007