Provider First Line Business Practice Location Address:
711 MAIN 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:
96130-4329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-257-8989
Provider Business Practice Location Address Fax Number:
530-257-4649
Provider Enumeration Date:
05/24/2007