Provider First Line Business Practice Location Address:
4500 47TH AVE STE 1
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:
95824-3848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-422-1917
Provider Business Practice Location Address Fax Number:
916-422-2459
Provider Enumeration Date:
03/20/2013