Provider First Line Business Practice Location Address:
815 30TH 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:
95816-4406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-287-0980
Provider Business Practice Location Address Fax Number:
916-891-1120
Provider Enumeration Date:
02/24/2026