Provider First Line Business Practice Location Address:
755 UNIVERSITY AVE
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:
95825-6708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-580-5769
Provider Business Practice Location Address Fax Number:
916-872-1311
Provider Enumeration Date:
01/30/2007