Provider First Line Business Practice Location Address:
1355 EAST ST STE 200
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:
96001-0801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-605-4263
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/01/2008