Provider First Line Business Practice Location Address:
5385 FRANKLIN BLVD STE K
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:
95820-4717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-569-8484
Provider Business Practice Location Address Fax Number:
530-661-1027
Provider Enumeration Date:
10/28/2015