Provider First Line Business Practice Location Address:
1923 COURT ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-1824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-229-7744
Provider Business Practice Location Address Fax Number:
530-229-7707
Provider Enumeration Date:
07/17/2006