Provider First Line Business Practice Location Address:
5120 J STREET
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-733-0655
Provider Business Practice Location Address Fax Number:
916-733-0650
Provider Enumeration Date:
05/19/2006