Provider First Line Business Practice Location Address:
670 PLACERVILLE DR STE 2
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:
95667-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-644-2412
Provider Business Practice Location Address Fax Number:
530-644-8563
Provider Enumeration Date:
05/10/2016