Provider First Line Business Practice Location Address:
8850 SOUTHSIDE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELK GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95624-2231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-686-7703
Provider Business Practice Location Address Fax Number:
916-610-1439
Provider Enumeration Date:
08/20/2026