Provider First Line Business Practice Location Address: 
444 W MINER ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
YREKA
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
96097-2839
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
530-842-7323
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/11/2011