Provider First Line Business Practice Location Address:
3379 OLD LANTERN DR
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:
96003-2179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-495-0527
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2026