Provider First Line Business Practice Location Address:
1100 BUTTE STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-401-2386
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/05/2012