Provider First Line Business Practice Location Address:
4602 VALLEY WEST BLVD
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:
95521-4636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-822-4689
Provider Business Practice Location Address Fax Number:
707-822-1400
Provider Enumeration Date:
08/21/2013