Provider First Line Business Practice Location Address:
1300 WEST ST STE 104
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:
96001-1692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-768-5051
Provider Business Practice Location Address Fax Number:
530-605-2723
Provider Enumeration Date:
11/16/2018