Provider First Line Business Practice Location Address:
101 HOSPITAL RD
Provider Second Line Business Practice Location Address:
TGH ML FAC - IP NON-CONTRACTED PRIOR TO 7-1-05
Provider Business Practice Location Address City Name:
SONORA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95370-5227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-533-7100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2007