Provider First Line Business Practice Location Address:
1650 OREGON ST STE 109
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:
96001-1754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-242-6079
Provider Business Practice Location Address Fax Number:
530-242-6079
Provider Enumeration Date:
07/25/2006