Provider First Line Business Practice Location Address:
2128 10TH 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:
95818-1314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-447-3291
Provider Business Practice Location Address Fax Number:
916-447-3292
Provider Enumeration Date:
02/20/2007