Provider First Line Business Practice Location Address:
11670 ATWOOD RD
Provider Second Line Business Practice Location Address:
CHAPA-DE INDIAN HEALTH PROGRAM
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95603-9522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-887-2836
Provider Business Practice Location Address Fax Number:
530-887-2842
Provider Enumeration Date:
09/25/2007