Provider First Line Business Practice Location Address:
1023 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:
95814-3507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-443-1711
Provider Business Practice Location Address Fax Number:
916-443-1712
Provider Enumeration Date:
01/11/2007