Provider First Line Business Practice Location Address:
1304 EAST ST STE 113
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:
96001-0855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-605-1361
Provider Business Practice Location Address Fax Number:
530-605-1363
Provider Enumeration Date:
02/04/2014