Provider First Line Business Practice Location Address:
1469 HUMBOLDT RD
Provider Second Line Business Practice Location Address:
SUITE #175
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95928-9116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-897-5100
Provider Business Practice Location Address Fax Number:
530-897-5105
Provider Enumeration Date:
04/14/2006