Provider First Line Business Practice Location Address:
2835 EASTERN AVE STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95821-5400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
279-238-4949
Provider Business Practice Location Address Fax Number:
279-238-4939
Provider Enumeration Date:
03/23/2026