Provider First Line Business Practice Location Address:
1827 CANAL ST
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:
95340-4812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-722-3832
Provider Business Practice Location Address Fax Number:
209-722-2779
Provider Enumeration Date:
12/24/2007