Provider First Line Business Practice Location Address:
2410 SONOMA ST STE 1
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:
96001-3029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-243-3339
Provider Business Practice Location Address Fax Number:
530-243-3582
Provider Enumeration Date:
05/22/2017