Provider First Line Business Practice Location Address:
4860 Y STREET
Provider Second Line Business Practice Location Address:
#2500,UC-DAVIS MEDICAL CENTER
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-6124
Provider Business Practice Location Address Fax Number:
916-457-6937
Provider Enumeration Date:
12/15/2005