Provider First Line Business Practice Location Address:
3798 JANES RD STE 6
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:
95521-4745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-825-4958
Provider Business Practice Location Address Fax Number:
707-825-4978
Provider Enumeration Date:
12/15/2021