Provider First Line Business Practice Location Address:
715 WEST F STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-847-2021
Provider Business Practice Location Address Fax Number:
209-847-7524
Provider Enumeration Date:
05/01/2007