Provider First Line Business Practice Location Address:
2409 L ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95816-5025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-448-1444
Provider Business Practice Location Address Fax Number:
916-447-2125
Provider Enumeration Date:
03/17/2009