Provider First Line Business Practice Location Address:
14732 BASS 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:
96003-7303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-275-5480
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2010