Provider First Line Business Practice Location Address:
2632 EDITH AVE 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:
96001-3031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-243-1166
Provider Business Practice Location Address Fax Number:
877-767-4831
Provider Enumeration Date:
08/20/2015