Provider First Line Business Practice Location Address:
3520 DAYTON 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:
95838-4006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-408-7199
Provider Business Practice Location Address Fax Number:
877-466-7829
Provider Enumeration Date:
09/16/2026