Provider First Line Business Practice Location Address:
1403 HILLTOP DR
Provider Second Line Business Practice Location Address:
MT SHASTA MALL
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96003-4001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-224-3724
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2007