Provider First Line Business Practice Location Address:
6512 WESTSIDE RD 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:
96001-4868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-229-9200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2010