Provider First Line Business Practice Location Address:
2005 RIVER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUSANVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-257-5341
Provider Business Practice Location Address Fax Number:
530-257-8150
Provider Enumeration Date:
01/17/2007