Provider First Line Business Practice Location Address:
1600 50TH 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:
95819-4409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-452-3509
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2008