Provider First Line Business Practice Location Address:
2825 WEST ST APT 1
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:
96001-3150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-242-1121
Provider Business Practice Location Address Fax Number:
530-242-1492
Provider Enumeration Date:
06/20/2023