Provider First Line Business Practice Location Address:
1135 PINE ST STE 21
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:
96001-0750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-638-2067
Provider Business Practice Location Address Fax Number:
949-561-5392
Provider Enumeration Date:
06/14/2021