Provider First Line Business Practice Location Address:
980 LAKE BLVD
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:
96003-1724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-246-7237
Provider Business Practice Location Address Fax Number:
530-246-0875
Provider Enumeration Date:
06/28/2007