Provider First Line Business Practice Location Address:
2623 24TH 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:
95818-2515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-704-7920
Provider Business Practice Location Address Fax Number:
916-444-2173
Provider Enumeration Date:
05/26/2009