Provider First Line Business Practice Location Address:
1796 CHURN CREEK RD
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:
96002-0263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-845-0630
Provider Business Practice Location Address Fax Number:
530-503-9803
Provider Enumeration Date:
06/29/2022