Provider First Line Business Practice Location Address:
15136 S HARLAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LATHROP
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95330-9754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-858-4700
Provider Business Practice Location Address Fax Number:
209-858-4704
Provider Enumeration Date:
03/23/2026