Provider First Line Business Practice Location Address:
3051 VICTOR AVENUE
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:
96002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-223-0583
Provider Business Practice Location Address Fax Number:
530-223-6316
Provider Enumeration Date:
12/03/2007