Provider First Line Business Practice Location Address:
381 BAYSIDE RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
ARCATA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95521-6497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-407-9492
Provider Business Practice Location Address Fax Number:
707-822-2102
Provider Enumeration Date:
10/09/2015