Provider First Line Business Practice Location Address:
1304 EAST ST STE 208
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:
96001-0855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-289-8011
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/30/2015