Provider First Line Business Practice Location Address:
1600 9TH ST
Provider Second Line Business Practice Location Address:
MS-3-8, RM 330
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95814-6414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-654-1605
Provider Business Practice Location Address Fax Number:
916-654-3255
Provider Enumeration Date:
04/10/2009