Provider First Line Business Practice Location Address:
1300 WEST ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-1663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-245-9928
Provider Business Practice Location Address Fax Number:
530-245-9938
Provider Enumeration Date:
07/21/2006