Provider First Line Business Practice Location Address:
1579 EDGEWOOD 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:
96003-9293
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-261-1044
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2006