Provider First Line Business Practice Location Address:
6950 65TH STREET
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:
95823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-393-1222
Provider Business Practice Location Address Fax Number:
916-567-4220
Provider Enumeration Date:
10/19/2010