Provider First Line Business Practice Location Address:
619 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:
530-891-4391
Provider Business Practice Location Address Fax Number:
530-891-0751
Provider Enumeration Date:
05/03/2006