Provider First Line Business Practice Location Address:
4150 V STREET, NEPHROLOGY
Provider Second Line Business Practice Location Address:
PSSB 3500
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95817-2201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-3774
Provider Business Practice Location Address Fax Number:
916-734-7920
Provider Enumeration Date:
10/29/2009