Provider First Line Business Practice Location Address:
317 LAKE BLVD STE A
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:
530-638-7474
Provider Business Practice Location Address Fax Number:
530-638-0405
Provider Enumeration Date:
08/01/2007