Provider First Line Business Practice Location Address:
630 SALEM ST
Provider Second Line Business Practice Location Address:
STE 210
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95928-5556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-519-4177
Provider Business Practice Location Address Fax Number:
530-345-7677
Provider Enumeration Date:
01/09/2007