Provider First Line Business Practice Location Address:
631 H 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-822-8975
Provider Business Practice Location Address Fax Number:
916-880-5693
Provider Enumeration Date:
08/04/2014