Provider First Line Business Practice Location Address:
3920 HIGH 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:
95838-3629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-827-5885
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2025