Provider First Line Business Practice Location Address:
3415 MARTIN LUTHER KING JR BLVD
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:
95817-3648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-233-4910
Provider Business Practice Location Address Fax Number:
916-731-8149
Provider Enumeration Date:
12/30/2009