Provider First Line Business Practice Location Address:
4320 MOUNTAIN LAKES BLVD
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:
96003-1438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-223-2080
Provider Business Practice Location Address Fax Number:
530-223-2521
Provider Enumeration Date:
12/13/2006