Provider First Line Business Practice Location Address:
275 HOSPITAL DR
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:
95482-4531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-462-7900
Provider Business Practice Location Address Fax Number:
707-462-7947
Provider Enumeration Date:
06/22/2006