Provider First Line Business Practice Location Address:
555 UNIVERSITY AVE STE 245
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-838-2236
Provider Business Practice Location Address Fax Number:
916-929-2246
Provider Enumeration Date:
04/25/2025