Provider First Line Business Practice Location Address:
2415 L ST
Provider Second Line Business Practice Location Address:
UPSTAIRS SUITE
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95816-5006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-448-0664
Provider Business Practice Location Address Fax Number:
916-442-0816
Provider Enumeration Date:
08/22/2006