Provider First Line Business Practice Location Address:
651 I 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-874-5183
Provider Business Practice Location Address Fax Number:
916-874-4669
Provider Enumeration Date:
06/01/2012