Provider First Line Business Practice Location Address:
1428 U 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:
95818-1489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-442-8911
Provider Business Practice Location Address Fax Number:
702-478-6469
Provider Enumeration Date:
02/24/2009