Provider First Line Business Practice Location Address:
914 MAIN 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:
96130-4407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-257-2225
Provider Business Practice Location Address Fax Number:
530-257-2225
Provider Enumeration Date:
01/08/2007