Provider First Line Business Practice Location Address:
1074 EAST AVE
Provider Second Line Business Practice Location Address:
SUITE S
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95926-1005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-891-3456
Provider Business Practice Location Address Fax Number:
530-891-8909
Provider Enumeration Date:
07/25/2006