Provider First Line Business Practice Location Address:
980 9TH ST UNIT 23-A
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:
95814-2719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-898-0111
Provider Business Practice Location Address Fax Number:
916-898-0071
Provider Enumeration Date:
04/16/2021