Provider First Line Business Practice Location Address:
562 MANZANITA AVENUE
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95926-4141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-898-1700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2006