Provider First Line Business Practice Location Address:
2180 HUMBOLDT RD
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:
95928-9124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-630-3003
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2026