Provider First Line Business Practice Location Address:
425 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95825-6520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-920-1222
Provider Business Practice Location Address Fax Number:
916-920-3222
Provider Enumeration Date:
03/16/2012