Provider First Line Business Practice Location Address:
1530 HUMBOLDT RD STE 4
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:
95928-9196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-343-5225
Provider Business Practice Location Address Fax Number:
530-876-1058
Provider Enumeration Date:
08/18/2006