Provider First Line Business Practice Location Address:
6424 WESTSIDE RD
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:
96001-4833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-243-3616
Provider Business Practice Location Address Fax Number:
530-243-0981
Provider Enumeration Date:
03/06/2007