Provider First Line Business Practice Location Address:
216 MILL VALLEY PKWY
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:
96003-5245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-746-6097
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2026