Provider First Line Business Practice Location Address:
528 14TH GENESIS BEHAVIOR CENTER, INC.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MODESTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-577-2014
Provider Business Practice Location Address Fax Number:
209-577-1718
Provider Enumeration Date:
10/09/2009