Provider First Line Business Practice Location Address:
1816 1ST ST
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:
96130-4561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-310-0572
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/19/2015