Provider First Line Business Practice Location Address:
1408 NORTH ST
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
SUSANVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96130-4082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-251-8511
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2007