Provider First Line Business Practice Location Address:
10423 OLD PLACERVILLE RD STE A
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:
95827-2540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-822-8958
Provider Business Practice Location Address Fax Number:
916-368-7945
Provider Enumeration Date:
07/25/2014