Provider First Line Business Practice Location Address:
1660 HUMBOLDT RD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95928-9199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-891-6521
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/26/2006