Provider First Line Business Practice Location Address:
1556 HARTNELL AVE STE D
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:
96002-2277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-241-0712
Provider Business Practice Location Address Fax Number:
530-222-5837
Provider Enumeration Date:
07/19/2006