Provider First Line Business Practice Location Address:
1421 16TH ST
Provider Second Line Business Practice Location Address:
FLOOR 2
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95814-5003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-224-0212
Provider Business Practice Location Address Fax Number:
916-415-7051
Provider Enumeration Date:
10/29/2010