Provider First Line Business Practice Location Address:
983 MISSION DE ORO DR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96003-3850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-222-5920
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2006