Provider First Line Business Practice Location Address:
2150 WESTERN AVE
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:
95521-5350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-846-8238
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2024