Provider First Line Business Practice Location Address:
10350 SOUTH MCKINLEY AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRENCH CAMP
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-323-4426
Provider Business Practice Location Address Fax Number:
209-323-4728
Provider Enumeration Date:
12/31/2007