Provider First Line Business Practice Location Address:
915 I 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:
95814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-808-7923
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2025