Provider First Line Business Practice Location Address:
3330 CHURN CREEK RD
Provider Second Line Business Practice Location Address:
STE D1
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96002-2532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-222-9643
Provider Business Practice Location Address Fax Number:
530-222-9602
Provider Enumeration Date:
06/21/2005