Provider First Line Business Practice Location Address:
1196 E LASSEN AVE STE 130
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:
95973-0892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-879-2456
Provider Business Practice Location Address Fax Number:
530-879-3932
Provider Enumeration Date:
02/22/2011