Provider First Line Business Practice Location Address:
238 HOSPITAL DR STE A
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:
95482-4559
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:
707-468-5272
Provider Enumeration Date:
10/16/2006