Provider First Line Business Practice Location Address:
574 E 12TH ST
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:
95928-5779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-354-0551
Provider Business Practice Location Address Fax Number:
530-809-4647
Provider Enumeration Date:
05/24/2021