Provider First Line Business Practice Location Address:
99 SCRIPPS DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95825-6317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-925-9222
Provider Business Practice Location Address Fax Number:
916-925-9264
Provider Enumeration Date:
10/18/2006