Provider First Line Business Practice Location Address:
801 CRESCENT WAY
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
ARCATA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95521-6780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-822-3998
Provider Business Practice Location Address Fax Number:
707-822-3998
Provider Enumeration Date:
02/22/2007