Provider First Line Business Practice Location Address:
2421 HARTNELL 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:
96002-2340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-527-1995
Provider Business Practice Location Address Fax Number:
866-527-2335
Provider Enumeration Date:
06/08/2012