Provider First Line Business Practice Location Address:
1281 NORTH AVENUE
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:
95838-3661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-924-6703
Provider Business Practice Location Address Fax Number:
916-922-4578
Provider Enumeration Date:
08/08/2006