Provider First Line Business Practice Location Address:
1760 GOLD ST
Provider Second Line Business Practice Location Address:
STE 500
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-1806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-244-9332
Provider Business Practice Location Address Fax Number:
530-244-0859
Provider Enumeration Date:
01/30/2006