Provider First Line Business Practice Location Address:
2757 CHURN CREEK RD
Provider Second Line Business Practice Location Address:
SUITE C-D
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96002-1170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-221-3713
Provider Business Practice Location Address Fax Number:
530-221-3932
Provider Enumeration Date:
03/23/2009