Provider First Line Business Practice Location Address:
4860 Y STREET SUITE 1100
Provider Second Line Business Practice Location Address:
UC DAVIS MEDICAL CENTER
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-6719
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/06/2005