Provider First Line Business Practice Location Address:
145 SPRUCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRIDLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95948-0947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-846-3604
Provider Business Practice Location Address Fax Number:
530-846-2108
Provider Enumeration Date:
04/19/2007