Provider First Line Business Practice Location Address:
643 W EAST 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:
95926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-892-9127
Provider Business Practice Location Address Fax Number:
530-809-4881
Provider Enumeration Date:
07/15/2010