Provider First Line Business Practice Location Address:
601 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE 175
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95825-6775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-866-1880
Provider Business Practice Location Address Fax Number:
323-866-1881
Provider Enumeration Date:
02/03/2012