Provider First Line Business Practice Location Address: 
1366 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: 
95926-7336
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
530-899-2322
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/01/2011