Provider First Line Business Practice Location Address:
219 PARKDALE AVE
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:
96130-3946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-232-2276
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2013