Provider First Line Business Practice Location Address:
1465 VICTOR AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96003-4856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-605-4557
Provider Business Practice Location Address Fax Number:
530-605-4531
Provider Enumeration Date:
11/10/2006