Provider First Line Business Practice Location Address:
186 E 12TH ST
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:
95928-5737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-231-2970
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2009