Provider First Line Business Practice Location Address:
480 E 13TH ST
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:
95341-6214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-381-6879
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2008