Provider First Line Business Practice Location Address:
910 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
RED BLUFF
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96080-2735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-527-2510
Provider Business Practice Location Address Fax Number:
530-529-1150
Provider Enumeration Date:
04/24/2007