Provider First Line Business Practice Location Address:
425 UNIVERSITY AVENUE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-924-9337
Provider Business Practice Location Address Fax Number:
916-924-8281
Provider Enumeration Date:
11/19/2012