Provider First Line Business Practice Location Address:
MOLINA MEDICAL CENTERS - SMO
Provider Second Line Business Practice Location Address:
954 SACRAMENTO AVENUE
Provider Business Practice Location Address City Name:
W. SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95605-1904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-373-1495
Provider Business Practice Location Address Fax Number:
916-373-0954
Provider Enumeration Date:
05/11/2007