Provider First Line Business Practice Location Address:
5200 CHURN CREEK RD
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96002-3930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-224-9341
Provider Business Practice Location Address Fax Number:
530-223-0977
Provider Enumeration Date:
07/19/2006