Provider First Line Business Practice Location Address:
1975 PLACER ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-1747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-227-0000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2016