Provider First Line Business Practice Location Address:
2135 AIRPARK DR STE B
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:
96001-2414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-605-4316
Provider Business Practice Location Address Fax Number:
530-605-4318
Provider Enumeration Date:
06/15/2017