Provider First Line Business Practice Location Address:
642 5TH ST STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUSA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95932-2656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-458-7342
Provider Business Practice Location Address Fax Number:
530-458-2373
Provider Enumeration Date:
07/10/2006