Provider First Line Business Practice Location Address:
2319 'K' 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:
95816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-444-3790
Provider Business Practice Location Address Fax Number:
916-444-3793
Provider Enumeration Date:
11/18/2008