Provider First Line Business Practice Location Address:
2150 MAIN ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED BLUFF
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96080-2372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-527-7951
Provider Business Practice Location Address Fax Number:
530-527-7955
Provider Enumeration Date:
08/30/2006