Provider First Line Business Practice Location Address: 
111 RALEY BLVD
    Provider Second Line Business Practice Location Address: 
SUITE 100
    Provider Business Practice Location Address City Name: 
CHICO
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
95928-8351
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
530-894-8800
    Provider Business Practice Location Address Fax Number: 
530-894-8929
    Provider Enumeration Date: 
09/25/2006