Provider First Line Business Practice Location Address:
1495 VICTOR AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96003-4093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-222-4156
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2011