Provider First Line Business Practice Location Address:
25 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95929-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-898-5923
Provider Business Practice Location Address Fax Number:
530-898-4870
Provider Enumeration Date:
03/17/2009