Provider First Line Business Practice Location Address:
120 AMBER GROVE DR
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95973-5878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-893-0275
Provider Business Practice Location Address Fax Number:
530-893-2631
Provider Enumeration Date:
01/18/2006