Provider First Line Business Practice Location Address:
629 ENTLER AVE
Provider Second Line Business Practice Location Address:
STE 3&4
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95928-7424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-895-8414
Provider Business Practice Location Address Fax Number:
530-895-8490
Provider Enumeration Date:
12/13/2006