Provider First Line Business Practice Location Address:
2301 PARK MARINA DR STE 19
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:
96001-2158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-241-4304
Provider Business Practice Location Address Fax Number:
530-241-2052
Provider Enumeration Date:
05/09/2007