Provider First Line Business Practice Location Address:
835 UNIVERSITY AVE
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:
95825-6724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-921-5954
Provider Business Practice Location Address Fax Number:
916-921-1268
Provider Enumeration Date:
02/23/2006