Provider First Line Business Practice Location Address:
801 CRESCENT WAY
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
ARCATA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95521-6780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-822-2711
Provider Business Practice Location Address Fax Number:
707-822-0885
Provider Enumeration Date:
09/06/2006