Provider First Line Business Practice Location Address:
115 LAKE BLVD E
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:
96003-2913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-229-1519
Provider Business Practice Location Address Fax Number:
530-229-1522
Provider Enumeration Date:
07/29/2006