Provider First Line Business Practice Location Address:
220 E 13TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERCED
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95341-6250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-383-3381
Provider Business Practice Location Address Fax Number:
209-722-2025
Provider Enumeration Date:
04/12/2010