Provider First Line Business Practice Location Address:
494 H ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ARCATA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95521-6370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-273-1347
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2016