Provider First Line Business Practice Location Address:
1145 WHISKEYTOWN CT
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-0227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-246-4180
Provider Business Practice Location Address Fax Number:
530-242-6421
Provider Enumeration Date:
08/22/2014