Provider First Line Business Practice Location Address:
1548 EAST ST
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:
96001-1109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
523-243-8064
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2007