Provider First Line Business Practice Location Address:
1465 VICTOR AVE STE A
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:
96003-4856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-605-3804
Provider Business Practice Location Address Fax Number:
530-605-3702
Provider Enumeration Date:
12/23/2014