Provider First Line Business Practice Location Address:
1145 WHISKEYTOWN COURT, SUITE A
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-242-6821
Provider Business Practice Location Address Fax Number:
530-242-6421
Provider Enumeration Date:
02/28/2007