Provider First Line Business Practice Location Address:
767 E YOSEMITE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERCED
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95340-8055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-737-0391
Provider Business Practice Location Address Fax Number:
831-232-0791
Provider Enumeration Date:
04/03/2026