Provider First Line Business Practice Location Address:
1401 GOLD ST STE B
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:
96001-1937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-337-5750
Provider Business Practice Location Address Fax Number:
530-337-5754
Provider Enumeration Date:
03/06/2017