Provider First Line Business Practice Location Address:
645 W EAST AVE
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95926-7201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-898-8405
Provider Business Practice Location Address Fax Number:
530-899-0944
Provider Enumeration Date:
06/22/2005