Provider First Line Business Practice Location Address:
2011 P 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:
95811-5225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-273-1112
Provider Business Practice Location Address Fax Number:
530-273-1112
Provider Enumeration Date:
01/14/2015