Provider First Line Business Practice Location Address:
242 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
UKIAH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95482-4556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-468-8944
Provider Business Practice Location Address Fax Number:
707-468-9685
Provider Enumeration Date:
12/14/2005