Provider First Line Business Practice Location Address:
500 W. HOSPITAL RD
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:
95231-9989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-468-6820
Provider Business Practice Location Address Fax Number:
209-468-3977
Provider Enumeration Date:
08/07/2006