Provider First Line Business Practice Location Address:
2279 45TH STREET
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:
95817-2229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-5959
Provider Business Practice Location Address Fax Number:
916-703-5265
Provider Enumeration Date:
11/30/2005