Provider First Line Business Practice Location Address:
390 W CLAY 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:
95482-5422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-462-1211
Provider Business Practice Location Address Fax Number:
707-462-5898
Provider Enumeration Date:
03/30/2007