Provider First Line Business Practice Location Address:
317 LAKE BLVD STE 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:
96003-2504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-351-7050
Provider Business Practice Location Address Fax Number:
530-351-7055
Provider Enumeration Date:
10/27/2016