Provider First Line Business Practice Location Address:
15660 MIDDLETOWN PARK DR
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:
96001-9794
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-244-1003
Provider Business Practice Location Address Fax Number:
530-242-6027
Provider Enumeration Date:
08/26/2006