Provider First Line Business Practice Location Address:
2160 COURT ST STE B
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:
96001-2544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-502-8823
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2021