Provider First Line Business Practice Location Address: 
950 THARP RD STE 1302
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
YUBA CITY
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
95993-8351
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
530-751-1225
    Provider Business Practice Location Address Fax Number: 
530-751-9863
    Provider Enumeration Date: 
06/16/2011