Provider First Line Business Practice Location Address:
1224 26TH 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:
95816-5618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-447-1731
Provider Business Practice Location Address Fax Number:
916-447-1736
Provider Enumeration Date:
10/23/2006