Provider First Line Business Practice Location Address:
1400 CHESTNUT STREET # A
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-251-8112
Provider Business Practice Location Address Fax Number:
530-251-5884
Provider Enumeration Date:
10/29/2010