Provider First Line Business Practice Location Address:
445 I ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CRESCENT CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95531-4026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-464-3709
Provider Business Practice Location Address Fax Number:
707-464-1881
Provider Enumeration Date:
03/19/2007