Provider First Line Business Practice Location Address: 
135 MISSION RANCH BLVD STE 100
    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: 
95926-2175
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
530-342-2411
    Provider Business Practice Location Address Fax Number: 
530-894-5783
    Provider Enumeration Date: 
07/01/2008