Provider First Line Business Practice Location Address:
2315 STOCKTON BLVD ROOM 4302
Provider Second Line Business Practice Location Address:
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:
916-703-3505
Provider Business Practice Location Address Fax Number:
916-734-1656
Provider Enumeration Date:
11/22/2005