Provider First Line Business Practice Location Address: 
1825 SONOMA ST
    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: 
96001-2519
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
530-243-8667
    Provider Business Practice Location Address Fax Number: 
530-243-8742
    Provider Enumeration Date: 
05/12/2006