Provider First Line Business Practice Location Address:
1220 25TH 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:
95816-5005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-306-8123
Provider Business Practice Location Address Fax Number:
916-306-8123
Provider Enumeration Date:
05/31/2006