Provider First Line Business Practice Location Address:
1205 LIBERTY ST APT 7
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:
96001-0830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-407-5701
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2025