Provider First Line Business Practice Location Address:
1068 EAST AVE STE A-1
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:
95926-1051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-891-1513
Provider Business Practice Location Address Fax Number:
530-891-6274
Provider Enumeration Date:
07/22/2006