Provider First Line Business Practice Location Address:
1388 COURT STREET
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-1650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-246-2207
Provider Business Practice Location Address Fax Number:
530-243-6835
Provider Enumeration Date:
10/27/2006