Provider First Line Business Practice Location Address:
2230 9TH 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:
95818-1310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-448-7391
Provider Business Practice Location Address Fax Number:
916-441-1600
Provider Enumeration Date:
12/24/2007