Provider First Line Business Practice Location Address:
445 HEMSTED DR
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96002-0143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-605-4671
Provider Business Practice Location Address Fax Number:
530-605-4673
Provider Enumeration Date:
04/26/2012