Provider First Line Business Practice Location Address:
130 AMBER GROVE DR
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95973-5875
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-895-7634
Provider Business Practice Location Address Fax Number:
530-342-2440
Provider Enumeration Date:
03/07/2007