Provider First Line Business Practice Location Address:
2212 13TH 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:
95818-1408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-283-1629
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2008