Provider First Line Business Practice Location Address:
414 22ND 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:
95816-3009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-6377
Provider Business Practice Location Address Fax Number:
916-734-1484
Provider Enumeration Date:
04/10/2024