Provider First Line Business Practice Location Address:
4001 HIGHWAY 104 MENTAL HEALTH DEPARTMENT
Provider Second Line Business Practice Location Address:
MULE CREEK STATE PRISON (CSP-MCSP)
Provider Business Practice Location Address City Name:
IONE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-497-5439
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2008