Provider First Line Business Practice Location Address:
3720 CHURN CREEK RD APT 7D
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:
96002-2900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-438-4395
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2023