Provider First Line Business Practice Location Address:
4612 ROOSEVELT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95820-4520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-379-5876
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2023