Provider First Line Business Practice Location Address:
1500 21ST 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:
95811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-443-3299
Provider Business Practice Location Address Fax Number:
916-325-1980
Provider Enumeration Date:
11/23/2005