Provider First Line Business Practice Location Address:
528 SO SCHOOL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UKIAH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-463-1887
Provider Business Practice Location Address Fax Number:
707-462-4050
Provider Enumeration Date:
10/13/2006