Provider First Line Business Practice Location Address:
1800 28TH 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:
95816-7310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-732-9040
Provider Business Practice Location Address Fax Number:
916-454-4559
Provider Enumeration Date:
09/25/2006