Provider First Line Business Practice Location Address:
151 ASH ST 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:
96130-4585
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-257-9597
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2006