Provider First Line Business Practice Location Address: 
1050 LIVE OAK BLVD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
YUBA CITY
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
95991-3415
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
530-671-1740
    Provider Business Practice Location Address Fax Number: 
530-671-1380
    Provider Enumeration Date: 
10/03/2006