Provider First Line Business Practice Location Address:
551 SHIRLEY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARCATA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95521-6533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-407-9776
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2026