Provider First Line Business Practice Location Address:
6400 GRANGERS DAIRY DR
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:
95831-1042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-395-3483
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2022