Provider First Line Business Practice Location Address:
2315 STOCKTON BLVD DEPT OF
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:
95817-2201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-703-2108
Provider Business Practice Location Address Fax Number:
916-734-8490
Provider Enumeration Date:
04/16/2019