Provider First Line Business Practice Location Address:
301 E 13TH ST STE A
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:
95341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-381-6852
Provider Business Practice Location Address Fax Number:
209-385-3174
Provider Enumeration Date:
03/27/2007