Provider First Line Business Practice Location Address:
KAISER FOUNDATION HOSPITAL- MODESTO
Provider Second Line Business Practice Location Address:
4601 DALE ROAD 3RD FLOOR
Provider Business Practice Location Address City Name:
MODESTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95356-2804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-735-4135
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2007