Provider First Line Business Practice Location Address:
4250 H ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95819-3441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-452-5055
Provider Business Practice Location Address Fax Number:
916-452-9325
Provider Enumeration Date:
10/30/2009