Provider First Line Business Practice Location Address:
707 J ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95814-2501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-443-8701
Provider Business Practice Location Address Fax Number:
916-443-8161
Provider Enumeration Date:
06/27/2007