Provider First Line Business Practice Location Address:
1655 E CYPRESS AVE 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:
96002-1345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-221-4321
Provider Business Practice Location Address Fax Number:
530-224-1238
Provider Enumeration Date:
09/22/2006