Provider First Line Business Practice Location Address:
1616 CHESTNUT ST
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:
96130-3720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-251-8128
Provider Business Practice Location Address Fax Number:
530-251-2668
Provider Enumeration Date:
02/07/2011