Provider First Line Business Practice Location Address:
1112 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED BLUFF
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96080-2749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-581-1202
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2010