Provider First Line Business Practice Location Address:
1600 HUMBOLDT RD STE 3
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:
95928-8100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-410-0505
Provider Business Practice Location Address Fax Number:
530-487-8608
Provider Enumeration Date:
10/15/2014