Provider First Line Business Practice Location Address:
3001 STATE UNIVERSITY DR BLDG B
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:
95826-2364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-495-7349
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/21/2023