Provider First Line Business Practice Location Address:
7215 55TH 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:
95823-2659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-803-2124
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2023