Provider First Line Business Practice Location Address:
88 W HIGHWAY 4
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
MURPHYS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95247-9494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-728-3472
Provider Business Practice Location Address Fax Number:
209-728-3478
Provider Enumeration Date:
12/15/2006