Provider First Line Business Practice Location Address:
554 WEST 25TH STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-383-6200
Provider Business Practice Location Address Fax Number:
209-383-5224
Provider Enumeration Date:
11/30/2006