Provider First Line Business Practice Location Address:
603 W F ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95361-3734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-404-6283
Provider Business Practice Location Address Fax Number:
209-848-8825
Provider Enumeration Date:
08/31/2006