Provider First Line Business Practice Location Address:
4202 H 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:
95819-3425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-452-6405
Provider Business Practice Location Address Fax Number:
916-452-9065
Provider Enumeration Date:
01/03/2012