Provider First Line Business Practice Location Address:
1221 E CYPRESS AVE SPC 25A
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:
96002-1137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-604-4782
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/14/2015