Provider First Line Business Practice Location Address:
1560 HUMBOLDT RD STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95928-9101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-809-1455
Provider Business Practice Location Address Fax Number:
530-965-5312
Provider Enumeration Date:
09/12/2021