Provider First Line Business Practice Location Address:
3269 1/2 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:
95816-5262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-426-8456
Provider Business Practice Location Address Fax Number:
916-245-6156
Provider Enumeration Date:
04/19/2013