Provider First Line Business Practice Location Address:
1400 CHESTNUT ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUSANVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96130-3773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-251-8451
Provider Business Practice Location Address Fax Number:
530-251-2660
Provider Enumeration Date:
03/12/2007