Provider First Line Business Practice Location Address:
1544 MAGNOLIA AVE
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:
96001-1513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-225-0350
Provider Business Practice Location Address Fax Number:
530-225-0108
Provider Enumeration Date:
11/28/2018