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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-472-2300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2017