Provider First Line Business Practice Location Address:
1111 24TH ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95816-5019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-441-0655
Provider Business Practice Location Address Fax Number:
916-441-6665
Provider Enumeration Date:
12/22/2009