Provider First Line Business Practice Location Address:
803 1/2 MAIN ST.,
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SUSANVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-257-3115
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2010