Provider First Line Business Practice Location Address:
1558 POOLE BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
YUBA CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95993-2607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-755-0882
Provider Business Practice Location Address Fax Number:
530-755-0885
Provider Enumeration Date:
10/12/2006