Provider First Line Business Practice Location Address:
1310 CHURN CREEK RD STE E1
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:
96003-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-272-2020
Provider Business Practice Location Address Fax Number:
561-828-8367
Provider Enumeration Date:
04/06/2022