Provider First Line Business Practice Location Address:
845 LAKEVIEW DR
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:
96001-0316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-680-2727
Provider Business Practice Location Address Fax Number:
530-605-2725
Provider Enumeration Date:
12/12/2022