Provider First Line Business Practice Location Address:
1120 S DORA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UKIAH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95482-6340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-472-2696
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2006