Provider First Line Business Practice Location Address:
405 SOUTH ST
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-2101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-246-0801
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2006