Provider First Line Business Practice Location Address:
2851 PARK MARINA DR STE 150
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:
96001-2813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-247-0858
Provider Business Practice Location Address Fax Number:
530-243-5942
Provider Enumeration Date:
02/21/2013