Provider First Line Business Practice Location Address:
2039 CANAL ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
MERCED
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95340-3726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-723-7761
Provider Business Practice Location Address Fax Number:
209-381-0322
Provider Enumeration Date:
04/08/2006