Provider First Line Business Practice Location Address:
739 10TH ST
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:
95521-6209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-822-2551
Provider Business Practice Location Address Fax Number:
707-822-2667
Provider Enumeration Date:
02/28/2007