Provider First Line Business Practice Location Address:
145 N 2ND AVE STE 5
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:
95361-3064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-848-2225
Provider Business Practice Location Address Fax Number:
209-848-0141
Provider Enumeration Date:
10/26/2006