Provider First Line Business Practice Location Address:
40 N MCDOW ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUSANVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96130-4555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-257-2725
Provider Business Practice Location Address Fax Number:
530-257-2854
Provider Enumeration Date:
04/10/2007