Provider First Line Business Practice Location Address:
2970 INNSBRUCK DR 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:
96003-9303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-222-5633
Provider Business Practice Location Address Fax Number:
530-222-5528
Provider Enumeration Date:
06/26/2008