Provider First Line Business Practice Location Address:
601 UNIVERSITY AVE STE 141
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:
95825-6738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-922-8329
Provider Business Practice Location Address Fax Number:
916-922-8359
Provider Enumeration Date:
11/20/2006