Provider First Line Business Practice Location Address:
2005 COURT ST
Provider Second Line Business Practice Location Address:
STE N
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-1807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-768-1633
Provider Business Practice Location Address Fax Number:
530-768-1634
Provider Enumeration Date:
01/29/2008