Provider First Line Business Practice Location Address:
2222 WATT AVE STE B5
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:
95825-0581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-483-8282
Provider Business Practice Location Address Fax Number:
916-483-6699
Provider Enumeration Date:
09/16/2009