Provider First Line Business Practice Location Address:
146 S WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SONORA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95370-4712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-532-6149
Provider Business Practice Location Address Fax Number:
209-532-1822
Provider Enumeration Date:
09/14/2007