Provider First Line Business Practice Location Address:
811 E 5TH AVE
Provider Second Line Business Practice Location Address:
ROOM #2
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95926-9592
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-715-1180
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2023