Provider First Line Business Practice Location Address:
500 W HOSPITAL RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRENCH CAMP
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95231-9693
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-468-6937
Provider Business Practice Location Address Fax Number:
209-468-6114
Provider Enumeration Date:
10/28/2021