Provider First Line Business Practice Location Address:
5642 J 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:
95819-3949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-857-8400
Provider Business Practice Location Address Fax Number:
916-244-3504
Provider Enumeration Date:
04/21/2021