Provider First Line Business Practice Location Address:
1255 EAST ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-0800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-244-9052
Provider Business Practice Location Address Fax Number:
530-244-9053
Provider Enumeration Date:
02/13/2007