Provider First Line Business Practice Location Address:
3605 HOSPITAL RD
Provider Second Line Business Practice Location Address:
SUITE M
Provider Business Practice Location Address City Name:
ATWATER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95301-5173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-383-5500
Provider Business Practice Location Address Fax Number:
209-383-6910
Provider Enumeration Date:
08/26/2005