Provider First Line Business Practice Location Address:
129 E. CENTER ST SUITE 3
Provider Second Line Business Practice Location Address:
129 E. CENTER ST. SUITE 3
Provider Business Practice Location Address City Name:
MANTECA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95337-8715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-239-5553
Provider Business Practice Location Address Fax Number:
209-239-5978
Provider Enumeration Date:
03/26/2007