Provider First Line Business Practice Location Address:
4501 X STREET
Provider Second Line Business Practice Location Address:
GROUND FLOOR
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95817-2229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-8295
Provider Business Practice Location Address Fax Number:
916-734-3239
Provider Enumeration Date:
07/25/2006