Provider First Line Business Practice Location Address:
555 HOSPITAL LN
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:
96130-4808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-251-8108
Provider Business Practice Location Address Fax Number:
530-251-8394
Provider Enumeration Date:
08/31/2017