Provider First Line Business Practice Location Address:
1355 EAST ST
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-0801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-229-7891
Provider Business Practice Location Address Fax Number:
530-229-7821
Provider Enumeration Date:
07/21/2005