Provider First Line Business Practice Location Address:
642 W MAIN ST
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:
95340-4718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-205-1058
Provider Business Practice Location Address Fax Number:
209-205-1062
Provider Enumeration Date:
02/18/2009