Provider First Line Business Practice Location Address:
1539 FRIENDLY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANTECA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95337-8097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-665-7379
Provider Business Practice Location Address Fax Number:
209-362-3700
Provider Enumeration Date:
03/28/2026