Provider First Line Business Practice Location Address:
1445 BUNYAN RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SUSANVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96130-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-251-8277
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/20/2009