Provider First Line Business Practice Location Address:
430 NORTH WASHINGTON STREET
Provider Second Line Business Practice Location Address:
SONORA HIGH SCHOOL
Provider Business Practice Location Address City Name:
SONORA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-533-5511
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/23/2020