Provider First Line Business Practice Location Address:
1560 HUMBOLDT RD
Provider Second Line Business Practice Location Address:
ST 5
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95928-9101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-692-2050
Provider Business Practice Location Address Fax Number:
530-692-2053
Provider Enumeration Date:
11/28/2005