Provider First Line Business Practice Location Address:
1020 29TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-887-7955
Provider Business Practice Location Address Fax Number:
916-887-7956
Provider Enumeration Date:
05/13/2021