Provider First Line Business Practice Location Address:
1647 HARTNELL AVE.
Provider Second Line Business Practice Location Address:
SUITE 14
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96002-2268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-605-3221
Provider Business Practice Location Address Fax Number:
530-410-6995
Provider Enumeration Date:
06/13/2007