Provider First Line Business Practice Location Address:
1388 COURT ST STE A
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:
96001-1650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-381-4525
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2009