Provider First Line Business Practice Location Address:
260 HOSPITAL DR
Provider Second Line Business Practice Location Address:
STE 111
Provider Business Practice Location Address City Name:
UKIAH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95482-4533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-468-8991
Provider Business Practice Location Address Fax Number:
707-468-1869
Provider Enumeration Date:
08/01/2007