Provider First Line Business Practice Location Address:
888 LAKESIDE VLG CMNS
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:
95928-3979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-332-6850
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2025