Provider First Line Business Practice Location Address:
130 FORD ST
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:
95482-4012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-462-3809
Provider Business Practice Location Address Fax Number:
707-462-9567
Provider Enumeration Date:
11/02/2005