Provider First Line Business Practice Location Address:
1890 PARK MARINA DR STE 218
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:
96001-0961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-638-2338
Provider Business Practice Location Address Fax Number:
530-348-5435
Provider Enumeration Date:
06/09/2025