Provider First Line Business Practice Location Address:
411 W 20TH STREET
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:
95340-3713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-722-8122
Provider Business Practice Location Address Fax Number:
209-722-9849
Provider Enumeration Date:
12/13/2005