Provider First Line Business Practice Location Address:
631 H 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:
95814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-569-8650
Provider Business Practice Location Address Fax Number:
916-554-5482
Provider Enumeration Date:
12/12/2012