Provider First Line Business Practice Location Address:
1425 W H ST
Provider Second Line Business Practice Location Address:
SUITE 330
Provider Business Practice Location Address City Name:
OAKDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95361-3588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-848-8133
Provider Business Practice Location Address Fax Number:
209-845-2134
Provider Enumeration Date:
11/02/2007