Provider First Line Business Practice Location Address:
3535 65TH ST
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:
95820-2057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-564-8439
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/29/2025