Provider First Line Business Practice Location Address:
450 CEDAR STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUSANVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96130-4327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-257-4404
Provider Business Practice Location Address Fax Number:
530-257-9280
Provider Enumeration Date:
12/13/2006