Provider First Line Business Practice Location Address:
2515 PARK MARINA DR STE 101
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:
96001-2831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-243-9463
Provider Business Practice Location Address Fax Number:
530-243-9499
Provider Enumeration Date:
03/15/2007