Provider First Line Business Practice Location Address:
1832 BUENAVENTURA BLVD
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:
96001-3828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-242-4682
Provider Business Practice Location Address Fax Number:
530-243-5965
Provider Enumeration Date:
05/27/2009