Provider First Line Business Practice Location Address:
1852 BUENAVENTURA BLVD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-6315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-247-1490
Provider Business Practice Location Address Fax Number:
530-247-1431
Provider Enumeration Date:
01/09/2007