Provider First Line Business Practice Location Address:
236 HOSPITAL DR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UKIAH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95482-4561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-462-6525
Provider Business Practice Location Address Fax Number:
707-462-6572
Provider Enumeration Date:
10/17/2007