Provider First Line Business Practice Location Address:
10533 S PRIEST 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:
95231-9721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-688-5998
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2026