Provider First Line Business Practice Location Address:
821 14TH ST
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:
95521-5830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-826-4649
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2026