Provider First Line Business Practice Location Address:
411 E CALIFORNIA AVE
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:
95521-5277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-510-4387
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2006