Provider First Line Business Practice Location Address:
1310 CHURN CREEK RD
Provider Second Line Business Practice Location Address:
SUITE E3 - E4
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96003-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-510-4963
Provider Business Practice Location Address Fax Number:
530-510-4884
Provider Enumeration Date:
05/02/2011