Provider First Line Business Practice Location Address:
1122 17TH 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:
95814-4014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-264-8066
Provider Business Practice Location Address Fax Number:
916-864-8077
Provider Enumeration Date:
06/07/2007