Provider First Line Business Practice Location Address:
756 S DORA 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:
95482-5336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-463-2966
Provider Business Practice Location Address Fax Number:
707-463-2970
Provider Enumeration Date:
08/03/2022