Provider First Line Business Practice Location Address:
1936 SHASTA ST STE B
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:
96001-0407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-241-9109
Provider Business Practice Location Address Fax Number:
530-241-9114
Provider Enumeration Date:
08/16/2007