Provider First Line Business Practice Location Address:
945 HICKORY STREET
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:
96080-3214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-527-1707
Provider Business Practice Location Address Fax Number:
530-527-1710
Provider Enumeration Date:
11/20/2006