Provider First Line Business Practice Location Address:
155 W EL PORTAL DR STE C
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:
95348-2856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-749-1444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/23/2026