Provider First Line Business Practice Location Address:
1211 MAGNOLIA AVE STE D
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:
96001-1522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-245-0502
Provider Business Practice Location Address Fax Number:
530-244-4338
Provider Enumeration Date:
08/02/2006