Provider First Line Business Practice Location Address:
145 HOSPITAL DR
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:
95482-4591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-462-2227
Provider Business Practice Location Address Fax Number:
707-462-2547
Provider Enumeration Date:
01/31/2007