Provider First Line Business Practice Location Address:
1065 EAST AVE STE C
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:
95926-1049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-373-3010
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2026