Provider First Line Business Practice Location Address:
2656 EDITH AVE
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-3043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-247-3733
Provider Business Practice Location Address Fax Number:
530-243-6807
Provider Enumeration Date:
08/05/2006