Provider First Line Business Practice Location Address:
1936 SHASTA ST
Provider Second Line Business Practice Location Address:
A
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-0407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-339-0920
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2006