Provider First Line Business Practice Location Address:
681 MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
PLACERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-622-4880
Provider Business Practice Location Address Fax Number:
530-622-2360
Provider Enumeration Date:
09/26/2018