Provider First Line Business Practice Location Address:
455 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95825-6513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-601-7783
Provider Business Practice Location Address Fax Number:
916-929-6001
Provider Enumeration Date:
12/20/2006