Provider First Line Business Practice Location Address:
1640 TEHAMA ST 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:
96001-1681
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-243-7307
Provider Business Practice Location Address Fax Number:
530-243-1292
Provider Enumeration Date:
06/21/2019