Provider First Line Business Practice Location Address:
405 SOUTH STREET
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-2101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-244-6054
Provider Business Practice Location Address Fax Number:
530-244-6056
Provider Enumeration Date:
05/04/2007