Provider First Line Business Practice Location Address:
2021 VICTOR AVE
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:
96002-0410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-223-0790
Provider Business Practice Location Address Fax Number:
530-223-3378
Provider Enumeration Date:
10/31/2005