Provider First Line Business Practice Location Address:
2510 AIRPARK DR STE 101
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:
96001-2461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-241-6656
Provider Business Practice Location Address Fax Number:
530-246-3642
Provider Enumeration Date:
06/21/2005