Provider First Line Business Practice Location Address:
568 MANZANITA AVE
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95926-1361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-898-8228
Provider Business Practice Location Address Fax Number:
530-898-8228
Provider Enumeration Date:
04/26/2007