Provider First Line Business Practice Location Address:
2005 COURT STREET
Provider Second Line Business Practice Location Address:
SUITE L
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-246-3906
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2007