Provider First Line Business Practice Location Address:
24 ANTELOPE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED BLUFF
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96080-2807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-528-1795
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2006