Provider First Line Business Practice Location Address:
1408 MAIN 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:
96130-4426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-257-3300
Provider Business Practice Location Address Fax Number:
530-257-3322
Provider Enumeration Date:
07/20/2006