Provider First Line Business Practice Location Address:
500 WEST HOSPITAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRENCH CAMP
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95231-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-473-6555
Provider Business Practice Location Address Fax Number:
209-473-6544
Provider Enumeration Date:
07/06/2007