Provider First Line Business Practice Location Address:
15347 MIDDLETOWN PARK DR
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:
96001-9736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-246-0317
Provider Business Practice Location Address Fax Number:
530-243-5089
Provider Enumeration Date:
11/21/2006