Provider First Line Business Practice Location Address: 
2295 HILLTOP DR STE 3
    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: 
96002-0515
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
530-355-8496
    Provider Business Practice Location Address Fax Number: 
530-725-8000
    Provider Enumeration Date: 
07/28/2014