Provider First Line Business Practice Location Address:
1400 NORTH 'A' STREET
Provider Second Line Business Practice Location Address:
BLDG A
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-440-1500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2017