Provider First Line Business Practice Location Address:
518 S SCHOOL ST
Provider Second Line Business Practice Location Address:
STE. 203
Provider Business Practice Location Address City Name:
UKIAH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95482-5479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
170-746-7136
Provider Business Practice Location Address Fax Number:
170-746-7136
Provider Enumeration Date:
09/26/2006