Provider First Line Business Practice Location Address:
1680 BUNYAN 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:
96130-3133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-251-5889
Provider Business Practice Location Address Fax Number:
530-251-8599
Provider Enumeration Date:
03/15/2007