Provider First Line Business Practice Location Address:
4603 DALE RD
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE MEDICAL OFFICES
Provider Business Practice Location Address City Name:
MODESTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95357-7680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-735-4287
Provider Business Practice Location Address Fax Number:
209-735-4283
Provider Enumeration Date:
06/13/2006