Provider First Line Business Practice Location Address:
1430 EAST AVE
Provider Second Line Business Practice Location Address:
STE 6
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95926-1628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-893-8913
Provider Business Practice Location Address Fax Number:
530-893-2434
Provider Enumeration Date:
06/16/2005