Provider First Line Business Practice Location Address:
820 18TH 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:
95814-2117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-310-0716
Provider Business Practice Location Address Fax Number:
916-685-0815
Provider Enumeration Date:
07/17/2006