Provider First Line Business Practice Location Address:
1890 PARK MARINA DR
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-0961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-244-3806
Provider Business Practice Location Address Fax Number:
530-246-9880
Provider Enumeration Date:
08/01/2016