Provider First Line Business Practice Location Address:
5450 POWER INN RD STE B
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:
95820-6749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-388-9418
Provider Business Practice Location Address Fax Number:
916-388-9273
Provider Enumeration Date:
09/03/2009