Provider First Line Business Practice Location Address:
2101 'O' STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERCED
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-722-6000
Provider Business Practice Location Address Fax Number:
209-722-6600
Provider Enumeration Date:
10/25/2010