Provider First Line Business Practice Location Address:
630 SALEM ST
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95928-5556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-898-8446
Provider Business Practice Location Address Fax Number:
530-898-8449
Provider Enumeration Date:
07/12/2006