Provider First Line Business Practice Location Address:
879 J ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
CRESCENT CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95531-8301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-465-6560
Provider Business Practice Location Address Fax Number:
707-465-6560
Provider Enumeration Date:
05/03/2007