Provider First Line Business Practice Location Address:
4868 X ST STE 4A
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:
95817-2205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-2823
Provider Business Practice Location Address Fax Number:
916-734-8094
Provider Enumeration Date:
03/23/2026