Provider First Line Business Practice Location Address:
600 F ST
Provider Second Line Business Practice Location Address:
SUITE 3-619
Provider Business Practice Location Address City Name:
ARCATA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95521-6301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-845-4584
Provider Business Practice Location Address Fax Number:
707-673-5756
Provider Enumeration Date:
08/11/2011