Provider First Line Business Practice Location Address:
10555 OLD PLACERVILLE RD
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:
95827-2503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-307-3585
Provider Business Practice Location Address Fax Number:
916-368-4490
Provider Enumeration Date:
07/29/2013