Provider First Line Business Practice Location Address:
1831 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:
95811-3003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-551-1545
Provider Business Practice Location Address Fax Number:
916-551-1546
Provider Enumeration Date:
10/25/2011