Provider First Line Business Practice Location Address:
2216 BUENAVENTURA BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-3838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-338-5304
Provider Business Practice Location Address Fax Number:
530-643-7316
Provider Enumeration Date:
05/31/2015