Provider First Line Business Practice Location Address:
147 NORTH HIGHWAY 49
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SONORA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-533-1397
Provider Business Practice Location Address Fax Number:
209-533-9620
Provider Enumeration Date:
03/28/2008