Provider First Line Business Practice Location Address:
2040 SHASTA ST STE C
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:
96001-0471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-638-3811
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2020