Provider First Line Business Practice Location Address:
2805 50TH ST
Provider Second Line Business Practice Location Address:
RM 2415, MIND INSTITUTE, UNIVERSITY OF CALIFORNIA DAVIS
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95817-2312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-703-0449
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2013