Provider First Line Business Practice Location Address:
1751 HATRNELL AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96002-0748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-223-2325
Provider Business Practice Location Address Fax Number:
530-223-2252
Provider Enumeration Date:
02/24/2006