Provider First Line Business Practice Location Address:
145 S WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE J.
Provider Business Practice Location Address City Name:
SONORA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95370-4722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-694-8585
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2007