Provider First Line Business Practice Location Address:
2185 CHURN CREEK RD
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96002-0747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-222-0350
Provider Business Practice Location Address Fax Number:
530-222-0351
Provider Enumeration Date:
01/06/2006