Provider First Line Business Practice Location Address:
350 E YOSEMITE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERCED
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95340-9100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-722-1392
Provider Business Practice Location Address Fax Number:
209-722-1393
Provider Enumeration Date:
08/30/2005