Provider First Line Business Practice Location Address:
201 29TH ST STE B
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:
95816-3288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-446-6921
Provider Business Practice Location Address Fax Number:
916-446-0640
Provider Enumeration Date:
05/16/2016