Provider First Line Business Practice Location Address: 
2445 ORO DAM BLVD E
    Provider Second Line Business Practice Location Address: 
SUITE 8
    Provider Business Practice Location Address City Name: 
OROVILLE
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
95966-6035
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
530-353-3332
    Provider Business Practice Location Address Fax Number: 
530-353-3335
    Provider Enumeration Date: 
06/03/2016