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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-468-6937
Provider Business Practice Location Address Fax Number:
209-468-7042
Provider Enumeration Date:
05/14/2007