Provider First Line Business Practice Location Address:
1255 LIBERTY ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-0814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-638-8733
Provider Business Practice Location Address Fax Number:
530-638-8738
Provider Enumeration Date:
09/04/2014