Provider First Line Business Practice Location Address:
500 UNIVERSITY AVENUE
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-925-2096
Provider Business Practice Location Address Fax Number:
916-925-1144
Provider Enumeration Date:
09/27/2006