Provider First Line Business Practice Location Address:
2450 ORO DAM BLVD E
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
OROVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95966-6052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-533-1234
Provider Business Practice Location Address Fax Number:
530-533-5678
Provider Enumeration Date:
10/29/2013