Provider First Line Business Practice Location Address:
500 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95825-6523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-922-3668
Provider Business Practice Location Address Fax Number:
916-920-1221
Provider Enumeration Date:
01/04/2006