Provider First Line Business Practice Location Address: 
2025 MORSE AVE
    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: 
95825-2115
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
916-973-5000
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
01/29/2018