Provider First Line Business Practice Location Address:
320 1ST STREET
Provider Second Line Business Practice Location Address:
#3
Provider Business Practice Location Address City Name:
MARYSVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-632-2997
Provider Business Practice Location Address Fax Number:
530-743-7791
Provider Enumeration Date:
03/19/2007