Provider First Line Business Practice Location Address:
1530 HUMBOLDT RD
Provider Second Line Business Practice Location Address:
SUITE 1B
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95928-9196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-410-0505
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/16/2017