Provider First Line Business Practice Location Address:
2600 MOOREHEAD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESCENT CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95531-7904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-487-1116
Provider Business Practice Location Address Fax Number:
707-487-3116
Provider Enumeration Date:
11/03/2005