Provider First Line Business Practice Location Address:
1037 PINE ST
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:
96001-0710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-768-0950
Provider Business Practice Location Address Fax Number:
530-232-5432
Provider Enumeration Date:
12/13/2025