Provider First Line Business Practice Location Address:
2118 P 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:
95816-6149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-416-1638
Provider Business Practice Location Address Fax Number:
866-683-7194
Provider Enumeration Date:
07/15/2016