Provider First Line Business Practice Location Address:
2501 CAPITOL AVENUE
Provider Second Line Business Practice Location Address:
UPSTAIRS
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95816-5808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-447-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2006