Provider First Line Business Practice Location Address:
3136 ACADEMY WAY
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:
95815-1503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-370-4702
Provider Business Practice Location Address Fax Number:
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Provider Enumeration Date:
05/18/2026