Provider First Line Business Practice Location Address:
2300 N ST STE 1
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:
95816-5757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-204-5689
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2026