Provider First Line Business Practice Location Address:
1252 MANZANITA AVE
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:
95926-7302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-288-9882
Provider Business Practice Location Address Fax Number:
888-870-9642
Provider Enumeration Date:
06/12/2026