Provider First Line Business Practice Location Address:
3415 MARTIN LUTHER KING JR. BLVD
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:
95817-3648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-646-8000
Provider Business Practice Location Address Fax Number:
916-822-8974
Provider Enumeration Date:
12/12/2012