Provider First Line Business Practice Location Address:
2650 21ST STREET
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:
95818-2539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-452-3143
Provider Business Practice Location Address Fax Number:
916-452-3145
Provider Enumeration Date:
05/10/2007