Provider First Line Business Practice Location Address:
C/O 2682 LA RINCONADA PLACE
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:
96002-3708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-224-9420
Provider Business Practice Location Address Fax Number:
530-224-1095
Provider Enumeration Date:
03/09/2010