Provider First Line Business Practice Location Address:
1722 3RD ST STE 101
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:
95811-6200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-400-0447
Provider Business Practice Location Address Fax Number:
916-442-3075
Provider Enumeration Date:
10/06/2026