Provider First Line Business Practice Location Address:
24 ANTELOPE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED BLUFF
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96080-2807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-605-4292
Provider Business Practice Location Address Fax Number:
530-605-4296
Provider Enumeration Date:
10/09/2007