Provider First Line Business Practice Location Address:
3258 NORTH STATE STREET
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:
95482-3052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-234-9472
Provider Business Practice Location Address Fax Number:
707-463-2045
Provider Enumeration Date:
03/03/2011