Provider First Line Business Practice Location Address:
5385 FRANKLIN BLVD
Provider Second Line Business Practice Location Address:
STE K
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:
916-428-0656
Provider Business Practice Location Address Fax Number:
916-476-3723
Provider Enumeration Date:
07/28/2016