Provider First Line Business Practice Location Address:
676 E 1ST AVE
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95926-3547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-342-5621
Provider Business Practice Location Address Fax Number:
530-342-6506
Provider Enumeration Date:
09/29/2010