Provider First Line Business Practice Location Address:
2469 OLD EUREKA WAY
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:
96001-0336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-733-6389
Provider Business Practice Location Address Fax Number:
818-918-9640
Provider Enumeration Date:
12/03/2025