Provider First Line Business Practice Location Address:
10387 PORTA DEGO WAY
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:
96003-9289
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-224-4716
Provider Business Practice Location Address Fax Number:
530-224-7168
Provider Enumeration Date:
08/28/2020