Provider First Line Business Practice Location Address:
2108 N ST
Provider Second Line Business Practice Location Address:
NUM 7934
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95816-5712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-445-5999
Provider Business Practice Location Address Fax Number:
323-544-4248
Provider Enumeration Date:
06/14/2024