Provider First Line Business Practice Location Address:
715 JACKSON ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
RED BLUFF
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96080-3757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-527-9242
Provider Business Practice Location Address Fax Number:
530-527-2401
Provider Enumeration Date:
08/14/2006