Provider First Line Business Practice Location Address:
6483 HUMBOLDT HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUREKA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95503-7413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-666-5646
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2025