Provider First Line Business Practice Location Address:
3051 FAIRFIELD STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-566-3490
Provider Business Practice Location Address Fax Number:
916-566-7815
Provider Enumeration Date:
09/07/2019