Provider First Line Business Practice Location Address:
4150 V ST
Provider Second Line Business Practice Location Address:
PSSB-SUITE 1200, MED: ANESTHESIA
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95817-1460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-7985
Provider Business Practice Location Address Fax Number:
916-734-2575
Provider Enumeration Date:
12/15/2005