Provider First Line Business Practice Location Address:
14740 BASS DR SPC 8
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:
96003-8403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-738-4017
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2022