Provider First Line Business Practice Location Address:
1109 HARTNELL AVE
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96002-2257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-222-5510
Provider Business Practice Location Address Fax Number:
530-222-5560
Provider Enumeration Date:
06/30/2006