Provider First Line Business Practice Location Address:
6765 GREEN VALLEY RD
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:
95667-8984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-622-5551
Provider Business Practice Location Address Fax Number:
530-622-5800
Provider Enumeration Date:
12/24/2007