Provider First Line Business Practice Location Address:
4268 BOSTON AVE
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:
96001-5814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-917-6628
Provider Business Practice Location Address Fax Number:
530-917-6628
Provider Enumeration Date:
06/15/2005