Provider First Line Business Practice Location Address:
1850 SPRING RIDGE DR
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:
96130-6100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-251-5000
Provider Business Practice Location Address Fax Number:
530-257-7187
Provider Enumeration Date:
07/26/2018