Provider First Line Business Practice Location Address:
505 W 20TH ST
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:
95340-3704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-725-2980
Provider Business Practice Location Address Fax Number:
209-725-2984
Provider Enumeration Date:
02/15/2007