Provider First Line Business Practice Location Address:
151 ASH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SUSANVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96130-4539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-257-2828
Provider Business Practice Location Address Fax Number:
530-257-0788
Provider Enumeration Date:
08/11/2006