Provider First Line Business Practice Location Address:
608 KENTUCKY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRIDLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95948-2118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-228-2816
Provider Business Practice Location Address Fax Number:
530-345-5514
Provider Enumeration Date:
10/28/2018