Provider First Line Business Practice Location Address:
1647 HARTNELL AVE STE 6
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:
96002-2268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-605-1505
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2006