Provider First Line Business Practice Location Address:
464 E YOSEMITE AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MERCED
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95340-8489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-725-7149
Provider Business Practice Location Address Fax Number:
209-726-0259
Provider Enumeration Date:
10/21/2008