Provider First Line Business Practice Location Address:
1600 SACRAMENTO INN WAY
Provider Second Line Business Practice Location Address:
SUITE 116
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95815-3457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-564-5551
Provider Business Practice Location Address Fax Number:
916-564-5553
Provider Enumeration Date:
10/15/2009