Provider First Line Business Practice Location Address:
2315 STOCKTON BLVD
Provider Second Line Business Practice Location Address:
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER 0102
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:
916-734-4742
Provider Business Practice Location Address Fax Number:
916-734-0635
Provider Enumeration Date:
03/27/2006