Provider First Line Business Practice Location Address:
5330 POWER INN RD STE A-3
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:
95820-6773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-286-5153
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2025