Provider First Line Business Practice Location Address:
3054 LAKE REDDING DR
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:
96003-3305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-245-6549
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2025