Provider First Line Business Practice Location Address:
5200 N LAKE RD
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:
95343-5001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-228-4266
Provider Business Practice Location Address Fax Number:
209-500-6335
Provider Enumeration Date:
07/31/2012