Provider First Line Business Practice Location Address:
240 HOSPITAL DR
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
UKIAH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95482-4558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-463-2400
Provider Business Practice Location Address Fax Number:
707-463-3520
Provider Enumeration Date:
05/24/2006