Provider First Line Business Practice Location Address:
455 I ST STE 207
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARCATA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-825-8123
Provider Business Practice Location Address Fax Number:
707-825-8123
Provider Enumeration Date:
07/25/2006