Provider First Line Business Practice Location Address:
700 LAUREL AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-847-0864
Provider Business Practice Location Address Fax Number:
209-847-7439
Provider Enumeration Date:
12/13/2006