Provider First Line Business Practice Location Address:
2335 LARKSPUR LN STE D
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:
96002-0617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-605-4280
Provider Business Practice Location Address Fax Number:
530-605-4285
Provider Enumeration Date:
07/31/2014