Provider First Line Business Practice Location Address:
1124 EL DORADO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESCENT CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95531-2111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-464-0310
Provider Business Practice Location Address Fax Number:
707-465-5024
Provider Enumeration Date:
09/11/2025