Provider First Line Business Practice Location Address:
85 SALE LN
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
RED BLUFF
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96080-2949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-527-8688
Provider Business Practice Location Address Fax Number:
530-527-8561
Provider Enumeration Date:
09/01/2006