Provider First Line Business Practice Location Address:
1125 16TH ST
Provider Second Line Business Practice Location Address:
STE 212
Provider Business Practice Location Address City Name:
ARCATA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95521-5585
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-822-7525
Provider Business Practice Location Address Fax Number:
707-822-7539
Provider Enumeration Date:
11/23/2005