Provider First Line Business Practice Location Address:
590 ANTELOPE BLVD STE 30
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED BLUFF
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96080-2474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-529-9454
Provider Business Practice Location Address Fax Number:
530-529-9456
Provider Enumeration Date:
09/24/2014