Provider First Line Business Practice Location Address:
145 S GILMAN 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:
96130-4512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-903-5777
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2013