Provider First Line Business Practice Location Address:
5150 46TH ST
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:
95820-5245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-241-3676
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2026