Provider First Line Business Practice Location Address:
3614 MCKINLEY 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:
95816-3416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-327-3766
Provider Business Practice Location Address Fax Number:
916-307-5188
Provider Enumeration Date:
04/12/2008