Provider First Line Business Practice Location Address:
817 HARRIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUREKA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95503-4541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-445-5493
Provider Business Practice Location Address Fax Number:
707-445-3552
Provider Enumeration Date:
08/20/2006