Provider First Line Business Practice Location Address:
1850 WALNUT ST BLDG G
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED BLUFF
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96080-3611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-529-7893
Provider Business Practice Location Address Fax Number:
530-527-0766
Provider Enumeration Date:
05/03/2013