Provider First Line Business Practice Location Address:
1246 EAST ST
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-0836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-243-2439
Provider Business Practice Location Address Fax Number:
530-246-0945
Provider Enumeration Date:
06/18/2006