Provider First Line Business Practice Location Address:
720 RICHMOND RD STE A
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:
96130-4824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-251-8481
Provider Business Practice Location Address Fax Number:
530-251-2672
Provider Enumeration Date:
12/31/2007