Provider First Line Business Practice Location Address:
3257 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:
95816-5220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-442-5891
Provider Business Practice Location Address Fax Number:
916-442-4432
Provider Enumeration Date:
02/04/2019