Provider First Line Business Practice Location Address:
580 MANZANITA AVE STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95926-1338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-899-3873
Provider Business Practice Location Address Fax Number:
530-899-3749
Provider Enumeration Date:
01/05/2021