Provider First Line Business Practice Location Address:
500 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95825-6504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-929-2526
Provider Business Practice Location Address Fax Number:
916-929-6128
Provider Enumeration Date:
10/28/2005