Provider First Line Business Practice Location Address:
5650 MARTIN LUTHER KING JR BLVD
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:
95824-1222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-296-3098
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2025