Provider First Line Business Practice Location Address:
5345 N EL DORADO ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
STOCKTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95207-5872
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-952-1561
Provider Business Practice Location Address Fax Number:
209-952-2962
Provider Enumeration Date:
09/20/2006