Provider First Line Business Practice Location Address:
1560 HUMBOLDT RD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95928-9101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-332-9703
Provider Business Practice Location Address Fax Number:
530-894-8505
Provider Enumeration Date:
10/31/2007