Provider First Line Business Practice Location Address:
375 SMILE PLACE SUITE B
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-221-3376
Provider Business Practice Location Address Fax Number:
530-221-3378
Provider Enumeration Date:
04/19/2007