Provider First Line Business Practice Location Address:
1530 HUMBOLDT RD STE 1A
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:
95928-9196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-989-2146
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2011