Provider First Line Business Practice Location Address:
105 HOSPITAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SONORA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95370-5227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-533-6245
Provider Business Practice Location Address Fax Number:
209-533-7007
Provider Enumeration Date:
04/29/2013