Provider First Line Business Practice Location Address:
1359 E LASSEN AVE
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:
95973-7824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-210-8147
Provider Business Practice Location Address Fax Number:
530-466-3154
Provider Enumeration Date:
10/13/2021