Provider First Line Business Practice Location Address:
144 HARTNELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96002-1842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-223-4849
Provider Business Practice Location Address Fax Number:
530-223-0944
Provider Enumeration Date:
02/27/2009