Provider First Line Business Practice Location Address:
101 W 2ND 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:
95926-3810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-894-8944
Provider Business Practice Location Address Fax Number:
530-894-8905
Provider Enumeration Date:
09/22/2005