Provider First Line Business Practice Location Address:
1430 ESPLANADE
Provider Second Line Business Practice Location Address:
STE 5
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95926-3366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-891-0553
Provider Business Practice Location Address Fax Number:
530-891-7524
Provider Enumeration Date:
06/27/2005