Provider First Line Business Practice Location Address:
2114 N 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:
95816-5712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-993-3200
Provider Business Practice Location Address Fax Number:
916-993-3201
Provider Enumeration Date:
05/22/2007