Provider First Line Business Practice Location Address:
5283 FOLSOM BLVD
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:
95819-4546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-451-6000
Provider Business Practice Location Address Fax Number:
916-471-0399
Provider Enumeration Date:
12/19/2006