Provider First Line Business Practice Location Address:
472-013 JOHNSTONVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUSANVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96130-8752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-257-2196
Provider Business Practice Location Address Fax Number:
530-257-2518
Provider Enumeration Date:
02/05/2007