Provider First Line Business Practice Location Address:
1505 VICTOR AVE
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:
96003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-319-7187
Provider Business Practice Location Address Fax Number:
855-765-5492
Provider Enumeration Date:
06/29/2012