Provider First Line Business Practice Location Address:
20 CONSTITUTION DR
Provider Second Line Business Practice Location Address:
SUITE #B
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95973-4906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-898-1100
Provider Business Practice Location Address Fax Number:
530-898-0200
Provider Enumeration Date:
12/05/2006