Provider First Line Business Practice Location Address:
3834 CANTERBURY 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:
96002-4888
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-722-9192
Provider Business Practice Location Address Fax Number:
530-223-3880
Provider Enumeration Date:
03/13/2008