Provider First Line Business Practice Location Address:
501 J STREET
Provider Second Line Business Practice Location Address:
PRIMARY CARE PHYSICIAN
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-497-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2009