Provider First Line Business Practice Location Address:
1611 PENINSULA DR
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:
95521-9658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-832-4194
Provider Business Practice Location Address Fax Number:
707-832-4194
Provider Enumeration Date:
02/27/2026