Provider First Line Business Practice Location Address:
2651 FAIRFIELD ST
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:
95815-2102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-223-3863
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2026