Provider First Line Business Practice Location Address:
686-700 HIGHWAY 36
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:
96130-0444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-257-9266
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/03/2007