Provider First Line Business Practice Location Address:
2730 S BONNYVIEW RD
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:
96001-4515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-423-1948
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2026