Provider First Line Business Practice Location Address:
3520 ELIZABETH WAY
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:
96001-3428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-646-8789
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/25/2011