Provider First Line Business Practice Location Address:
6242 WESTSIDE RD APT 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:
96001-4851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-782-2417
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2026