Provider First Line Business Practice Location Address:
9985 FOLSOM BLVD
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:
95827-1405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-270-4626
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2025