Provider First Line Business Practice Location Address:
7237 E SOUTHGATE DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-423-6866
Provider Business Practice Location Address Fax Number:
916-393-6100
Provider Enumeration Date:
01/03/2007