Provider First Line Business Practice Location Address: 
2145 5TH AVE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
OROVILLE
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
95965-5870
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
530-534-5394
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
10/27/2015