Provider First Line Business Practice Location Address:
1459 HUMBOLDT RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95928-9100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-855-0213
Provider Business Practice Location Address Fax Number:
530-466-3741
Provider Enumeration Date:
02/16/2006