Provider First Line Business Practice Location Address:
2020 29TH ST
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95817-1119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-455-2391
Provider Business Practice Location Address Fax Number:
916-455-2393
Provider Enumeration Date:
03/25/2014