Provider First Line Business Practice Location Address:
723 CLAIM STAKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LATHROP
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95330-8851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-395-5649
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/21/2026