Provider First Line Business Practice Location Address:
6386 GREELEY HILL RD
Provider Second Line Business Practice Location Address:
NORTHSIDE CLINIC
Provider Business Practice Location Address City Name:
COULTERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-878-0155
Provider Business Practice Location Address Fax Number:
209-878-0145
Provider Enumeration Date:
08/23/2006