Provider First Line Business Practice Location Address:
9700 WEST TARON DRIVE
Provider Second Line Business Practice Location Address:
CALIFORNIA NORTHSTATE UNIVERSITY
Provider Business Practice Location Address City Name:
ELK GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-686-7300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2017