Provider First Line Business Practice Location Address:
2901 K ST
Provider Second Line Business Practice Location Address:
STE 209
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95816-5124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-744-2627
Provider Business Practice Location Address Fax Number:
916-737-5226
Provider Enumeration Date:
10/25/2016