Provider First Line Business Practice Location Address:
8742 LEMAS RD
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:
95828-5887
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-582-2567
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2023