Provider First Line Business Practice Location Address:
279 RIO LINDO AVE APT 15
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:
95926-1986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-232-0845
Provider Business Practice Location Address Fax Number:
530-242-0801
Provider Enumeration Date:
08/20/2026