Provider First Line Business Practice Location Address:
643 W EAST AVE
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:
95926-7201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-342-0502
Provider Business Practice Location Address Fax Number:
530-342-2978
Provider Enumeration Date:
06/27/2005