Provider First Line Business Practice Location Address:
3050 VICTOR AVE SUITE 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:
96002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-221-1312
Provider Business Practice Location Address Fax Number:
530-221-4291
Provider Enumeration Date:
01/17/2007