Provider First Line Business Practice Location Address:
708 W 20TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MERCED
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95340-3639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-384-2335
Provider Business Practice Location Address Fax Number:
209-384-2342
Provider Enumeration Date:
12/13/2007