Provider First Line Business Practice Location Address:
735 12TH ST
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:
95521-5865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-616-5283
Provider Business Practice Location Address Fax Number:
707-633-2955
Provider Enumeration Date:
05/01/2013