Provider First Line Business Practice Location Address:
1359 E LASSEN 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:
95973-7824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-253-9054
Provider Business Practice Location Address Fax Number:
530-466-3154
Provider Enumeration Date:
08/29/2025