Provider First Line Business Practice Location Address:
407 E PERKINS 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:
95482-4506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-463-0160
Provider Business Practice Location Address Fax Number:
707-463-0532
Provider Enumeration Date:
09/16/2006