Provider First Line Business Practice Location Address:
1988 PARK MARINA DR
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:
96001-0912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-241-1559
Provider Business Practice Location Address Fax Number:
530-241-4298
Provider Enumeration Date:
12/11/2014