Provider First Line Business Practice Location Address:
1800 SPRING RIDGE DR
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:
96130-6100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-788-8103
Provider Business Practice Location Address Fax Number:
608-788-8799
Provider Enumeration Date:
12/04/2014