Provider First Line Business Practice Location Address:
1390 E LASSEN AVE
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:
95973-7823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-332-7479
Provider Business Practice Location Address Fax Number:
530-893-6853
Provider Enumeration Date:
10/24/2006