Provider First Line Business Practice Location Address:
2632 EDITH AVENUE, STE C
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:
96001-9600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-247-0404
Provider Business Practice Location Address Fax Number:
530-247-0472
Provider Enumeration Date:
03/20/2006