Provider First Line Business Practice Location Address:
2279 45TH ST BLDG 1
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:
95817-1514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-703-2616
Provider Business Practice Location Address Fax Number:
916-734-0980
Provider Enumeration Date:
07/24/2019