Provider First Line Business Practice Location Address:
1425 WEST H ST
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
OAKDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95361-3590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-848-1005
Provider Business Practice Location Address Fax Number:
209-845-8918
Provider Enumeration Date:
03/14/2007