Provider First Line Business Practice Location Address:
1640 TEHAMA ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-1617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-243-7307
Provider Business Practice Location Address Fax Number:
530-243-1292
Provider Enumeration Date:
05/29/2007