Provider First Line Business Practice Location Address:
1610 ARDEN WAY STE 119
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:
95815-4027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-879-1382
Provider Business Practice Location Address Fax Number:
916-400-9321
Provider Enumeration Date:
01/20/2026