Provider First Line Business Practice Location Address:
3420 31ST 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:
95817-3517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-666-8658
Provider Business Practice Location Address Fax Number:
530-666-8663
Provider Enumeration Date:
04/02/2007