Provider First Line Business Practice Location Address:
3648 EL PORTAL DR
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:
96002-3133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-722-1114
Provider Business Practice Location Address Fax Number:
530-722-1115
Provider Enumeration Date:
02/27/2013