Provider First Line Business Practice Location Address:
801 CRESCENT WAY
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
ARCATA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95521-6781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-822-5900
Provider Business Practice Location Address Fax Number:
707-822-4190
Provider Enumeration Date:
10/14/2005