Provider First Line Business Practice Location Address:
7707 S. AUSTIN ROAD
Provider Second Line Business Practice Location Address:
DEPARTMENT OF STATE HOSPITALS-STOCKTON
Provider Business Practice Location Address City Name:
STOCKTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-654-2351
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2013