Provider First Line Business Practice Location Address:
1246 EAST ST
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-0836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-242-5848
Provider Business Practice Location Address Fax Number:
530-242-5848
Provider Enumeration Date:
06/24/2008