Provider First Line Business Practice Location Address:
5735 47TH AVE.
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:
95824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-718-1633
Provider Business Practice Location Address Fax Number:
916-939-2409
Provider Enumeration Date:
11/24/2008