Provider First Line Business Practice Location Address:
645 ANTELOPE BLVD
Provider Second Line Business Practice Location Address:
SUITE 24
Provider Business Practice Location Address City Name:
RED BLUFF
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96080-2465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-528-7650
Provider Business Practice Location Address Fax Number:
530-528-7655
Provider Enumeration Date:
03/28/2006