Provider First Line Business Practice Location Address:
2774 WESTERN OAK DR
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:
96002-5116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-377-0157
Provider Business Practice Location Address Fax Number:
530-364-0404
Provider Enumeration Date:
11/01/2025