Provider First Line Business Practice Location Address:
1816 FIRST STREET
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:
96130-5110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-252-6595
Provider Business Practice Location Address Fax Number:
530-252-6595
Provider Enumeration Date:
04/13/2011