Provider First Line Business Practice Location Address:
423 DEER RIVER WAY
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:
95831-2456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-217-8472
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2026