Provider First Line Business Practice Location Address:
1401 21ST ST STE 11884
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:
95811-5226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-799-3119
Provider Business Practice Location Address Fax Number:
213-444-7714
Provider Enumeration Date:
06/04/2026