Provider First Line Business Practice Location Address:
720 ASH ST
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:
96130-3716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-257-7256
Provider Business Practice Location Address Fax Number:
530-257-3546
Provider Enumeration Date:
03/25/2007