Provider First Line Business Practice Location Address:
3798 JANES RD STE 6
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:
95521-4745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-785-4665
Provider Business Practice Location Address Fax Number:
208-785-2199
Provider Enumeration Date:
01/30/2007