Provider First Line Business Practice Location Address: 
480 PLUMAS BLVD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
YUBA CITY
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
95991-5005
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
530-749-3520
    Provider Business Practice Location Address Fax Number: 
530-749-3624
    Provider Enumeration Date: 
08/04/2006