Provider First Line Business Practice Location Address:
945 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95825-6712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-947-4002
Provider Business Practice Location Address Fax Number:
916-648-1383
Provider Enumeration Date:
12/14/2007