Provider First Line Business Practice Location Address:
1545 PAUL BUNYAN RD
Provider Second Line Business Practice Location Address:
BLDG A
Provider Business Practice Location Address City Name:
SUSANVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96130-3144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-257-7513
Provider Business Practice Location Address Fax Number:
530-257-7528
Provider Enumeration Date:
10/31/2006