Provider First Line Business Practice Location Address: 
1035 PLACER 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: 
96001-1125
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
530-246-5710
    Provider Business Practice Location Address Fax Number: 
530-241-7838
    Provider Enumeration Date: 
08/16/2006